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Ulcerative Colitis

Ulcerative colitis (Colitis ulcerosa) is a form of inflammatory bowel disease. It characteristically involves the colon and extends proximally from the anal verge. The exact etiology of ulcerative colitis is unknown.


Presentation

Individuals with ulcerative colitis can present rectal bleeding, mucous discharge from the rectum, and/or frequent stools. Individuals, who suffer from more severe cases of ulcerative colitis, can also have lower abdominal pain caused by purulent rectal discharge, severe dehydration, diarrhea and cramps, fever, leukocytosis, and/or abdominal distention. Fifteen percent of cases will have severe enough attacks to require steroid therapy and a hospital stay.

A potentially severe condition associated with ulcerative colitis is primary sclerosing cholangistis (PSC). This condition can result in jaundice and liver failure, leading to the need for a liver transplant. 75% of patients with PSC have IBD.

In severe cases requiring pouch procedures, additional symptoms can occur.

Ulcerative colitis can be associated with extra colonic problems such as:

Multiple sclerosis, immunobullous disease of the skin, and recurrent subcutaneous abscesses unrelated to pyoderma gangrenosum can also be associated with ulcerative colitis [1] [2].

Weight Loss
  • Signs and symptoms include abdominal pain, diarrhea, fever, weight loss, and intestinal hemorrhage. Chronic inflammation of the colon that produces ulcers in its lining.[icd9data.com]
  • Other symptoms may include Anemia Severe tiredness Weight loss Loss of appetite Bleeding from the rectum Sores on the skin Joint pain Growth failure in children About half of people with UC have mild symptoms.[nlm.nih.gov]
  • Abstract A man aged 78 years presented with a 3-week history of tender mouth ulceration associated with arthralgia and weight loss.[ncbi.nlm.nih.gov]
  • Our data suggested that casticin attenuated body weight loss, colon length shortening, and pathological damage in the colon of DSS-treated mice.[ncbi.nlm.nih.gov]
  • Or, if you have lost a significant amount of weight, you can qualify under the SSA's disability listing for weight loss, which requires a BMI of 17.5 or less.[disabilitysecrets.com]
Fever
  • The clinical course showed fever of short duration and elevation of liver enzymes without further clinical complications. Yellow fever viremia was not detectable and protective antibodies were developed.[ncbi.nlm.nih.gov]
  • Intravenous ampicillin improved the symptoms of fever, bloody diarrhea, and headache without any neurological sequelae.[ncbi.nlm.nih.gov]
  • KEYWORDS: Familial Mediterranean fever; Neonatal; Ulcerative colitis[ncbi.nlm.nih.gov]
  • Although a relatively rare condition, Sweet's syndrome should be considered as a differential diagnosis in patients with acute onset of high fever and skin rash, as it may have notable internal involvement and can be easily treated.[ncbi.nlm.nih.gov]
  • The patient referred an acute bloody and mucous diarrhea, lasting for three weeks, with no fever or rectal tenesmus. Stool studies were negative.[ncbi.nlm.nih.gov]
Anemia
  • This patient was evaluated for iron deficiency anemia and underwent hemicolectomy for extensive right-side predominant inflammatory pseudopolyps.[ncbi.nlm.nih.gov]
  • Other symptoms may include Anemia Severe tiredness Weight loss Loss of appetite Bleeding from the rectum Sores on the skin Joint pain Growth failure in children About half of people with UC have mild symptoms.[nlm.nih.gov]
  • Complete blood cell count and blood chemistries may be ordered, looking for anemia (low red blood cell count) and other abnormalities, including those from dehydration.[doi.org]
  • Other symptoms may include anemia, severe tiredness, weight loss, loss of appetite, bleeding from the rectum, sores on the skin and joint pain. Children with the disease may have growth problems.[icd9data.com]
  • Laboratory studies showed elevated C-reactive protein (CRP, 42 mg/l), fecal-calprotectin (7,223 μg/g), and anemia (hemoglobin 10.4 g/dl). Clostridium difficile and CMV infection were excluded.[ncbi.nlm.nih.gov]
Malaise
  • We report the case of a young male with known history of ulcerative colitis and abrupt onset of high fever, malaise, blurred vision and eruption of painful erythematous nodules and papules, localized on the head, neck, trunk and upper limbs.[ncbi.nlm.nih.gov]
  • ., tiredness or malaise) fever over 37.5 C, especially when disease symptoms are severe Some people with colitis develop arthritis, skin rashes, or inflammation of the eye, and about 4% get liver disease.[medbroadcast.com]
  • There may be symptoms of systemic upset, including malaise, fever, weight loss and symptoms of extra-intestinal (joint, cutaneous and eye) manifestations.[patient.info]
  • Systemic symptoms and signs, more common with extensive ulcerative colitis, include malaise, fever, anemia, anorexia, and weight loss.[merckmanuals.com]
Chills
  • Photo Credit Dolly Faibyshev for The New York Times Work Out and Chill? Cool temperature workouts may be the answer for those who want to exercise without becoming a hot mess.[nytimes.com]
  • Approximately 10% of infliximab infusions are associated with mild reactions such as headache, dizziness, fever, chills, chest pain, cough dyspnea or pruritus.[doi.org]
  • He denied history of any fever, chills, anorexia, or weight loss. On initial presentation, his vital signs were stable.[doi.org]
Diarrhea
  • He continued to experience watery diarrhea, which was attributed to intractable UC, and he underwent protectomy several weeks later. The histopathology of rectum revealed KS. After surgery, watery diarrhea resolved completely.[ncbi.nlm.nih.gov]
  • Signs and symptoms include abdominal pain, diarrhea, fever, weight loss, and intestinal hemorrhage. Chronic inflammation of the colon that produces ulcers in its lining.[icd9data.com]
  • Intravenous ampicillin improved the symptoms of fever, bloody diarrhea, and headache without any neurological sequelae.[ncbi.nlm.nih.gov]
  • We report a case of a 42-year-old man who presented with hypovolemic shock secondary to diarrhea and recently diagnosed nonischemic cardiomyopathy (left ventricular ejection fraction, 0.29).[ncbi.nlm.nih.gov]
  • The main symptom of the disease is bloody diarrhea, and a person who has this symptom is usually referred to a gastroenterologist, a doctor who specializes in the management of digestive disorders.[doi.org]
Abdominal Pain
  • Signs and symptoms include abdominal pain, diarrhea, fever, weight loss, and intestinal hemorrhage. Chronic inflammation of the colon that produces ulcers in its lining.[icd9data.com]
  • A 64-year-old man was admitted to the hospital with petechiae and palpable purpura in lower limbs and abdominal pain for about 1 month.[ncbi.nlm.nih.gov]
  • Appendectomy for an inflammatory condition (appendicitis or lymphadenitis) but not for nonspecific abdominal pain is associated with a low risk of subsequent ulcerative colitis.[ncbi.nlm.nih.gov]
  • A 15-year-old girl with a history of ulcerative colitis was admitted to the pediatric emergency department with abdominal pain attacks for the past 2 weeks.[ncbi.nlm.nih.gov]
  • Within two months, she was re-admitted to our hospital, presenting with hematochezia and lower abdominal pain. She was diagnosed with ulcerative colitis. In situ hybridization for EBV was positive in initial liver biopsy and colon biopsy.[ncbi.nlm.nih.gov]
Rectal Bleeding
  • Its major symptoms include diarrhea, rectal bleeding, the passage of mucus, and abdominal pain. Ulcerative colitis is a disease that causes ulcers in the lining of the rectum and colon.[icd10data.com]
  • Diarrhea, which may be bloody Rectal bleeding Abdominal pain and cramping Anemia Weight loss Arthritis, mouth sores, skin rashes, and eye inflammation may accompany ulcerative colitis in some individuals.[doi.org]
  • Other common symptoms include: abdominal pain fatigue weight loss loss of appetite rectal bleeding loss of body fluids and nutrients anemia caused by severe bleeding Some patients may also experience: skin lesions joint pain eye inflammation iver disorders[childrenshospital.org]
  • Inflammation is confined to the area closest to the anus (rectum), and rectal bleeding may be the only sign of the disease. This form of ulcerative colitis tends to be the mildest. Proctosigmoiditis.[mayoclinic.org]
Loss of Appetite
  • Other symptoms may include Anemia Severe tiredness Weight loss Loss of appetite Bleeding from the rectum Sores on the skin Joint pain Growth failure in children About half of people with UC have mild symptoms.[nlm.nih.gov]
  • Other symptoms may include anemia, severe tiredness, weight loss, loss of appetite, bleeding from the rectum, sores on the skin and joint pain. Children with the disease may have growth problems.[icd9data.com]
  • This leads to many common symptoms of ulcerative colitis including: Diarrhea or loose stool Abdominal pain Bowel urgency Blood in the stool Loss of appetite Weight loss Outside of the intestine, ulcerative colitis can lead to many symptoms in other parts[uclahealth.org]
  • Other common symptoms include: abdominal pain fatigue weight loss loss of appetite rectal bleeding loss of body fluids and nutrients anemia caused by severe bleeding Some patients may also experience: skin lesions joint pain eye inflammation iver disorders[childrenshospital.org]
Abdominal Cramps
  • Signs and symptoms include bloody diarrhea, abdominal cramping and pain on the left side, and unintended weight loss. Pancolitis.[mayoclinic.org]
  • Attacks can also involve bloody diarrhea, abdominal cramps and pain. People suffering from ulcerative colitis may experience alternating periods of diarrhea and constipation.[disabilitysecrets.com]
  • The most common symptoms of UC include: Abdominal cramping. Pain. Diarrhea. Bleeding with bowel movements. Fever. Fatigue. Weight loss. DIAGNOSIS The first step is to undergo a thorough medical history and physical exam.[fascrs.org]
  • Abdominal cramps and diarrhea may be helped by medications that reduce inflammation in the colon. More serious cases may require steroid drugs, antibiotics, or drugs that affect the body's immune system. Hospitalization.[stanfordchildrens.org]
Arthritis
  • Golimumab is a human IgG1-kappa anti-TNF antibody that has been approved for the treatment of rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and ulcerative colitis.[ncbi.nlm.nih.gov]
  • Xeljanz, made by Pfizer Labs, was previously approved in 2012 for rheumatoid arthritis and in 2017 for psoriatic arthritis. The FDA, an agency within the U.S.[fda.gov]
  • Janus kinases inhibitors have already been incorporated into the management of immune-mediated diseases, such as rheumatoid arthritis, and are being investigated for the treatment of psoriasis and inflammatory bowel diseases, both ulcerative colitis and[ncbi.nlm.nih.gov]
  • Several reports showed that emodin had efficacy on acute pancreatitis, keratitis, myocarditis, and rheumatoid arthritis. However, the potency of emodin on ulcerative colitis(UC) remains unclear.[ncbi.nlm.nih.gov]
  • CASE REPORT A 57-year-old female African American, with a past medical history of ulcerative colitis (UC) and arthritis, was treated with infliximab and prednisone.[ncbi.nlm.nih.gov]
Arthralgia
  • Abstract A man aged 78 years presented with a 3-week history of tender mouth ulceration associated with arthralgia and weight loss.[ncbi.nlm.nih.gov]
  • Behçet disease (intestinal BD) and inflammatory bowel disease (IBD) share a lot of characteristics, including genetic background, clinical manifestations, and therapeutic strategies, especially the extraintestinal manifestations, such as oral ulcers, arthralgia[ncbi.nlm.nih.gov]
  • Vedolizumab: In the large GEMINI I study, no significant difference was observed among the study groups for the most commonly reported adverse events: Namely, flare of UC, headache, nasopharyngitis and arthralgia.[doi.org]
  • The most common side effects with Entyvio (which may affect more than 1 in 10 people) are nasopharyngitis (inflammation of the nose and throat such as a cold), headache and arthralgia (joint pain).[ema.europa.eu]

Workup

Laboratory studies are typically used to assess the patient’s nutritional status and exclude other diagnoses, but the presence of serologic markers can be helpful in diagnosing an IBD. Acute infective enterocolitis, caused by Entamoeba histolytica, cytomegalovirl colitis, and Salmonela, Shigella, Isospora, or Yersinia may present with similar findings to ulcerative colitis, especially on CT scans. It is possible to diagnose ulcerative colitis in its early stages through the use of a double-contrast barium enema examination, because it is capable is picking up finer details. A complete blood count which includes anemia (hemoglobin < 14 g/dL in males and <12 g/dL in females) and thrombocytosis (platelet count > 350,000/µL) should be done. Hypoalbuminemia (albumin < 3.5 g/dL), hypokalemia (postassium < 3.5 mEq/L), elevated alkaline phosphatase, and hypomagnesemia (magnesium, 1.5 mg/dL) will be looked for in a comprehensive metabolic panel.

Inflammation markers such as an elevation of C-reactive protein levels and erythrocyte sedimentation rates may also be looked for. Stool studies will be conducted in order to determine if there is an underlying cause that is not ulcerative colitis.

Ulcerative colitis is typically diagnosed with a mucosal biopsy and an endoscopy for histopathology. Additional laboratory studies can be conducted in order to assess the patient’s nutritional health, and to exclude other diagnoses. The presence of serologic markers help to diagnose the existence of an IBD. A chromoendoscopy can also be conducted upon the doctor’s recommendation, to examine the colitis setting for precancerous changes and polyps.

X-Ray Abnormal
  • Home » Galleries » Abdominal X-ray » Abnormalities » 1 2 3 4 5 6 7 8 9 10 11 12 Ulcerative colitis - Thumbprinting Hover on/off image to show/hide findings Tap on/off image to show/hide findings Ulcerative colitis - Thumbprinting Abdominal X-rays are[radiologymasterclass.co.uk]
Thrombocytosis
  • A complete blood count which includes anemia (hemoglobin 14 g/dL in males and 12 g/dL in females) and thrombocytosis (platelet count 350,000/µL) should be done.[symptoma.com]
  • Other possible laboratory abnormalities include leukocytosis, thrombocytosis, and elevated acute-phase reactants (eg, ESR, C-reactive protein). X-rays are not diagnostic but occasionally show abnormalities.[merckmanuals.com]
Hyponatremia
  • Following recovery from infection and resolution of the hyponatremia, the patient was discharged to a senior care facility, but with continued treatment with TMP-SMX.[ncbi.nlm.nih.gov]
Colitis
  • Ulcerative colitis has several synonyms: Colitis gravis, idiopathic non-specific ulcerative colitis, chronic non-specific ulcerative colitis, and idiopathic proctocolitis.[symptoma.com]
  • ‎ (3 D) G Gross pathology of ulcerative colitis ‎ (4 D) H Histopathology of ulcerative colitis ‎ (18 D) X X-rays of ulcerative colitis ‎ (3 D) Medien in der Kategorie „Ulcerative colitis“ Folgende 10 Dateien sind in dieser Kategorie, von 10 insgesamt[commons.wikimedia.org]
  • E Endoscopic images of ulcerative colitis ‎ (3 F) G Gross pathology of ulcerative colitis ‎ (4 F) H Histopathology of ulcerative colitis ‎ (18 F) X X-rays of ulcerative colitis ‎ (3 F) File nella categoria "Ulcerative colitis" Questa categoria contiene[commons.wikimedia.org]
  • Here, we report a rare case of ulcerative colitis with Guillain-Barré Syndrome. We described a patient with Guillain-Barré syndrome during the remission period of ulcerative colitis.[ncbi.nlm.nih.gov]
  • The endoscopic and histopathological findings of this disease are sometimes similar to those of ulcerative colitis, and several reports describe cases of diverticular colitis that progressed to typical ulcerative colitis.[ncbi.nlm.nih.gov]
Colonic Ulcer
  • Ulcers form where inflammation has killed the cells that usually line the colon. Ulcerative colitis can happen at any age, but it usually starts between the ages of 15 and 30. It tends to run in families.[icd9data.com]
  • Ulcerative colitis, on the other hand, is continuous inflammation of the colon Ulcerative colitis only affects the inner most lining of the colon while Crohn's disease can occur in all the layers of the bowel walls Indeterminate Colitis Approximately[gastro.ucla.edu]
  • Crohn disease affects both the small intestine and the colon. Ulcerative colitis is found almost equally in men and women and tends to appear in young adults, although it can be diagnosed at any age.[doi.org]
  • Ulcerative colitis only involves the innermost lining of your colon. Ulcerative colitis can happen at any age, but most commonly occurs before the age of 30 or after the age of 60.[stanfordhealthcare.org]
  • The combination of inflammation and ulceration can cause abdominal discomfort and frequent emptying of the colon. Ulcerative colitis is the result of an abnormal response by your body's immune system.[crohnscolitisfoundation.org]
Multiple Ulcerations
  • Multiple ulcers in segmented pattern were noticed in the left hemi-colon using colonoscopy. An UC in active stage was confirmed subsequently by histology.[ncbi.nlm.nih.gov]

Treatment

Treatment for ulcerative colitis depends on extent of involvement and severity. The goal is to induce and maintain remission. Corticosteroids and anti-inflammatory agents together with symptomatic treatment are commonly used. Surgery is indicated when medical treatment fails or in case of a surgical emergency.

Prognosis

While ulcerative colitis can lead to disease related death, mortality is typically not increased in patients who suffer from it. When an increased mortality rate is seen it is typically in older patients or in cases where complications develop. Specifically the development of toxic megacolon is related to increased mortality. The longer that a person suffers from ulcerative colitis, the higher their risk of developing a colonic malignancy is.

Etiology

Ulcerative colitis is thought to have etiology in the areas of genetics, immune reactions, environmental factor, as well as others [1] [2] [3] [4].

Genetics

It is currently believed that abnormality of cell-mediated and humoral immunity occur in individuals who are more susceptible to ulcerative colitis. Individuals with ulcerative colitis also appear to be more sensitive to the bowels naturally occurring bacteria. A family history of ulcerative colitis increases the individual’s risk of suffering from it at some time in their life. Multiple loci have been identified which are associated with ulcerative colitis, Crohn's disease, and sometimes colorectal cancer.

Immune reactions

Patients with ulcerative colitis, often have serum and mucosal antibodies which attack the epithelial barrier of the intestines. This is a possible cause of ulcerative colitis. Additionally, a correlation between having an appendectomy and decreased risk of developing ulcerative colitis has been identified.

Environmental factors

Sulfate reducing bacteria’s are commonly found in patients with ulcerative colitis leading to higher amounts of sulfide, and altering the naturally occurring bacteria flora that lives in our intestines.

Other

Lower levels of vitamins A and E are found in 16% of children with ulcerative colitis. Smoking and milk consumption can trigger ulcerative colitis. Ulcerative colitis can be agitated by psychological and psychosocial stressors.

Epidemiology

With 1 million people in the US affected, ulcerative colitis has a prevalence rate of 35-100 cases in 100,000, and an incidence rate of 10.4-12 cases in 100,000. Higher numbers of Caucasians than African Americans suffer from ulcerative colitis, with Ashkenazi Jews being 2-4 times more likely to have it [5]. Women are more likely to suffer from ulcerative colitis than men, and it is typically diagnosed in age ranges of 15-25 years old and 55-65 years old. Twenty to twenty-five percent of cases occur in people 20 or younger with only 2 in 100,000 children affected. Incidences of ulcerative colitis are low in Asia and the Far East.

Sex distribution
Age distribution

Pathophysiology

Ulcerative colitis is characterized by changes to the immune system. The lamina propia accumulates extra T-cells, which are cytotoxic to the colonic epithelium. In addition, B cells, plasma cells, and immunoglobulin G and E increase. Ulcerative colitis patients have been observed to have anticolonic antibodies, as well as antiskeletal antibodies in limited cases. These antibodies attack the colon or skeletal system causing the patient discomfort or pain.

Microscopic changes include abscesses, inflamed crypts of Lieber Kuhn, and acute chronic inflamed infiltrate of the lamina propria. Granulation tissue will quickly cover the ulcerated areas. Ulcerative colitis typically begins at the anal verge and extends, without interruption, to all, or part of the colon. Ninety-five percent of cases involve the rectum. The terminal ileum is impacted in about 10% of cases. Superficial mucosal inflammation is caused by noxious inflammatory mediates backing up.

Prevention

There are no guidelines for prevention of ulcerative colitis.

Summary

Ulcerative colitis along with Crohn's disease, are both types of inflammatory bowel diseases (IBD). Ulcerative colitis typically affects the large bowel, while Crohn's disease impacts the whole gastrointestinal tract. The origins of ulcerative colitis are unknown, but it seems to be caused by a genetic predisposition and immune dysfunction. There is a strong correlation with histocompatibility human leukocyte antigen, (HLA)-B27 but the risk of having ulcerative colitis is not increased by having HLA-B27.

Ulcerative colitis can be impacted by the patient’s diet by agitating their already damaged mucous linings [1] [2]. Though it can occur at any age, ulcerative colitis typically occurs between the ages of 15 and 25 or between the ages of 55 and 65. Ulcerative colitis sufferers typically have a wall lining that is thin to normal in thickness. But it can present as thickened due to hypertrophy and enema.

Ulcerative colitis has several synonyms: Colitis gravis, idiopathic non-specific ulcerative colitis, chronic non-specific ulcerative colitis, and idiopathic proctocolitis.

Patient Information

Ulcerative colitis is an inflammatory bowel disease that impacts the large intestine (i.e. colon). With ulcerative colitis the lining of the large intestines is inflamed, can have sores, produce mucous or pus, and can develop ulcers. As a result you can experience abdominal discomfort and the need to frequently empty your intestines. Ulcerative colitis is an auto immune disease which impacts your intestines because your body has misinterpreted the bacteria, food and other materials located in the large intestines as germs which need to be destroyed. If you have ulcerative colitis you could experience urgent and looser bowel movements, bloody stool, persistent diarrhea, and/or crampy abdominal pain. You may lose your appetite, feel fatigued, and or lose weight. It is possible for you to experience no discomfort at all between colitis flare-ups.

References

Article

  1. Cotran RS, Collins T, Robbins SL, Kumar V. Pathologic Basis of Disease. Philadelphia, Pa: WB Saunders; 1998.
  2. Xavier RJ, Podolsky DK. Unravelling the pathogenesis of inflammatory bowel disease. Nature. Jul 26 2007;448(7152):427-34.
  3. Barrett JC, Lee JC, Lees CW, et al. Genome-wide association study of ulcerative colitis identifies three new susceptibility loci, including the HNF4A region. Nat Genet. Dec 2009;41(12):1330-4.
  4. Bousvaros A, Zurakowski D, Duggan C, et al. Vitamins A and E serum levels in children and young adults with inflammatory bowel disease: effect of disease activity. J Pediatr Gastroenterol Nutr. Feb 1998;26(2):129-35.
  5. Garland CF, Lilienfeld AM, Mendeloff AI, Markowitz JA, Terrell KB, Garland FC. Incidence rates of ulcerative colitis and Crohn's disease in fifteen areas of the United States. Gastroenterology. Dec 1981;81(6):1115-24.

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Last updated: 2018-06-22 06:00