ULCERATIVE COLITIS - SURGERY- 2021 - EASYMEDNOTES

Ulcerative colitis


It is an inflammatory condition of rectum and colon.

Related to stress, westernized diet, autoimmune factor, familial tendency, allergic factor.

Disease commonly starts in the rectum, spreads proximally to the colon and often into the ileum as back wash ileitis.

Aetiology

  •  Westernized diet, red meat and very less common in vegetarians. 
  • Defective mucin production in the colonic mucosa and mucosal immunological reaction.
  •  Autoimmune factors - Cytotoxic T lymphocytes against colonic epithelial cells and presence of anticolon antibodies. Association with HLA DR2 is observed in ulcerative colitis. 

  •  Familial in nature.
  •  Allergy to milk and other dietary factors.
  •  Excess reactive oxidative metabolism in ulcerative colitis. 
  •  Psychological aspects, stress, life style, personality disorders
Appendicectomy and smoking protects ulcerative colitis especially from extraintestinal features and from postoperative complications.

Pathology

  • To starts as multiple minute ulcers occur with proctitis and colitis.
  • These ulcers extend into the deeper layer and Spasm of the bowel will occur. Which results in Stricture of the colon
  • Then colon will Permanently contracts
  • In between ulcers, epithelial thickening occurs which appears like polyps : Pseudopolyposis


Clinical grading of ulcerative colitis

Mild Moderate Severe Stool frequency < 4 4-6 > 6 Pulse < 90 90-100 >100 Hematocrit Normal 30-40 < 30 Temperature Normal 99-100 > 100 ESR < 20 20-30 > 30 Albumin Normal 3-3.5 < 3.5

Clinical features

Disease basically begins in rectum as proctitis later it becomes left sided colitis and eventually causes severe total proctocolitis.

  • More common in females usually begins in 3rd decades
  • Watery diarrhoea, mucus or blood stained discharge in rectum.
  • Colicky pain, spasms.
  • Decreased appetite and loss of weight.

  • Relapses and remissions at regular intervals.

Two types of presentations

a. Fulminant type, 5% common

 • It is a severe form, with continuous diarrhoea with passage of blood, mucus and pus. 

• Patient will be ill and dehydrated. 

• Mimics fulminant amoebic colitis; severe typhoid and dysentery.

 • Fever, hypokalemia, acidosis, dehydration and shock. 

• Abdominal distension occurs. 

 b. Chronic type (95%):

 • Lasts for months to years with diarrhoea, blood loss, anaemia, invalidism, abdominal discomfort and pain.

 • Severe malnutrition and hypoproteinaemia.

Investigations 

• Barium enema shows loss of haustrations, narrow contracted colon (hose pipe colon), mucosal changes, pseudo polyps. It is avoided in fulminant cases. 

• Sigmoidoscopy and biopsy

• Colonoscopy.

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