Write about Ulcerative Colitis here.

• Relapsing and remitting inflammatory disorder of the colonic mucosa

• May affect just the rectum (proctitis)

or

• Extend proximally to involve part or all of the colon (pancolitis)

• It 'never' spreads proximally to the ileocaecal valve (except for 'backwash ileitis')

Pathology:

• Hyperaemic/haemorrhagic granular colonic mucosa ± 'pseudopolyps' formed by imflammation

• Punctate ulcers may extend deep into the lamina propria

Histology:

• Inflammatory infiltrate

• Goblet cell depletion

• Glandular distortion

• Mucosal ulcers

• Crypt abscesses

Cause:

• Unknown, though there is some genetic susceptibility

Incidence:

• 4-11/100 000 in the developed world

• Most present aged 15-30 years

• UC is TWICE as common in non-smokers (cf. Crohn's)

Prevalence:

• 100-200/100 000

Symptoms:

• Gradual onset of diarrhoea± blood and mucus

• Crampy abdo discomfort is common

• Bowel frequency related to severity of disease

• Systemic symptoms are common during attacks, e.g. fever malaise etc.

• Urgency and tenesmus occur with rectal disease

Signs:

• May be none

• In acute severe UC: fever, tachycardia and tender distended abdomen

• Extra GI signs: 

• clubbing

• aphthous oral ulcers

• erythema nodosum

• pyoderma gangrenosum

• conjunctivitis

• episcleritis

• iritis

• large joint arthritis

• sacroiliitis

• ankylosing spondylitis

• fatty liver

• PSC

• cholangiocarcinoma

Very Rarely

• Renal Stones

• Osteomalacia

• Nutritional deficiencies

• Systemic Amyloidosis

Severity:

Mild Moderate Severe

Motions/day <4 4-6 >6

Rectal bleeding Small Moderate Large

Temp @ 6am Apyrexial 37.1-37.8 >37.8

Pulse rate <70 70-90 >90

Hb >11 g/dL 10.5-11 g/dL <10.5 g/dL

ESR <30 mm/h >30 mm/h