-IBIS-1.5.0-
tx
digestive system
ulcerative colitis
diagnoses

definition and etiology

definition: A chronic inflammatory, ulcerative disease of the large bowel, recognized mostly by bloody diarrhea.

etiology: The disease is seen in both sexes equally, though whites and Jews are more often affected. Peak occurrence is from 15-35 years old, although any age is susceptible. Many factors may be involved in the development of ulcerative colitis: food sensitivities, poor stress management, genetics, infectious, and immunologic abnormalities have been implicated. The disease typically begins in the sigmoid colon and/or rectum, and then usually progresses proximally until the entire colon is affected. In ulcerative colitis, only the colonic mucosa is involved, and the lesions are uniform and continuous with no areas of normal tissue interspersed between the diseased mucosa.

signs and symptoms

signs and symptoms: onset may be insidious or dangerously acute

• increased urgency to defecate: up to 10-20 times/day
• bloody, watery and mucous bowel movements: may just consist of blood and pus
• abdominal cramping: may also have severe tenesmus
• in severe acute attacks: sudden, extreme diarrhea; fever; peritonitis; toxic colitis
• if the disease is limited to the rectosigmoidal area, then the stools may be normal or dry (there can be constipation), but rectal mucous high in WBCs and RBCs accompanies defecation, or occurs between bowel movements

• systemic and extracolonic symptoms include: fever; malaise; anorexia; weight loss; dehydration; arthritis; skin changes; liver disease; posterior uveitis, etc.; decreased growth and development, failure to thrive (in children)

lab findings:
• (+) sigmoidoscopy
• hypoalbuminemia
• increased ESR and CRP
• iron deficiency anemia (may be profound)
• leukocytosis and eosinophilia, or monocytosis
• may see B12 or folate deficiency
• CEA may be increased
• decreased electrolytes from dehydration and diarrhea
• mild liver enzyme changes, especially alk. phos. elevation
• may see false (+) RF

course and prognosis

The disease is recurrent: most patients experience another attack within a year of their first attack. However, there may also be long times of remission when symptoms, if present, are mild and benign. Approximately 85% of patients have mild to moderate disease that can be easily managed without hospital care. In about 10-15% of patients, the disease presents much more seriously, particularly in the elderly, and the prognosis is very unfavorable.

Complications include hemorrhage; toxic colitis (causing ileus, peritonitis and toxic megacolon); small rectovaginal fistulae; colon cancer (in patients having the entire colon affected and in patients afflicted with the disease for > 10 years); and biliary dysplasia and cancer.

Conventional treatment consists of dietary counseling ("normal diet but without raw fruits and vegetable roughage": Merck); no milk if the patient is sensitive to it; drugs (particularly sulfasalazine, hydrocortisone suppositories or injection); and surgery (eventually performed on a third of UC patients).

differential diagnosis

• regional enteritis
• irritable bowel syndrome
• malabsorption syndromes
• infectious gastroenteritis
• parasitic infections


footnotes