Ulcerative Colitis

Overview

Ulcerative colitis is a relapsing and remitting inflammatory disorder of the colonic mucosa. It may affect just the rectum or extend to involve part of the colon or entire colon. It never spreads proximal to the ileocaecal valve.

Signs and Symptoms

Diarrhea often with blood or pus, Abdominal pain and cramping, Tenesmus, Rectal bleeding, Mucus discharge, Urgency to defecate, Weight loss, Malaise, Loss of appetite, Fever, Anemia, Extracolonic manifestations-clubbing, aphthous oral ulcer, erythema nodosum, conjunctivitis

Common Causes

Inappropriate immune response against colonic flora in genetically susceptible individuals

Risk Factors

Immune system malfunction, Heredity: First degree relative who is having this disease, Age: can occur at any age but usually before the age of 30 years, Ethnicity: Asians are lower risk. Ashkenazi Jewish has higher risk

Investigation Techniques

Full blood count, Stool sample, Colonoscopy, Flexible sigmoidoscopy, Erected chest X-ray - rule out perforation, Abdominal X-ray, Computed tomography(CT) abdomen

Treatment and Prevention

5-aminosalicylic acid, Corticosteroids, Azathioprine and cyclosporin: can be used to maintain remission and as steroid-sparing agent, Monoclonal antibodies: infliximab and adalimumab, Antibiotics: to prevent and control infection, Anti-diarrheal medicine: loperamide is helpful but should be taken with caution as it can cause toxic megacolon, Iron supplements: to support iron deficiency anemia, Surgical therapy: subtotal colectomy and end ileostomy, proctocolectomy and permanent ileostomy, Restorative proctocolectomy with ileoanal pouch, Subtotal colectomy and ileorectal anastomosis