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.

• 2% of patients who undergo a pouch procedure become completely incontinent
• 3% of males experience sexual dysfunction due to impotence or retrograde ejaculation
• 6% of females experience sexual dysfunction

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

• Erythema nodosum
• Uveitis
• Pleuritis
• Spondyloarthropathies
• Ankylosing spondylitis
• Pyoderma gangrenosum

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

  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]

  Signs and symptoms include bloody diarrhea, abdominal cramping and pain on the left side, and unintended weight loss. Pancolitis. [mayoclinic.org]

  In addition to bloody diarrhea and abdominal pain on the left side, a patient may also experience weight loss. [self.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]

• Fever

  Intravenous ampicillin improved the symptoms of fever, bloody diarrhea, and headache without any neurological sequelae. [ncbi.nlm.nih.gov]

  The person also may have a fever and a poor appetite and may lose weight. [msdmanuals.com]

• Anemia

  This patient was evaluated for iron deficiency anemia and underwent hemicolectomy for extensive right-side predominant inflammatory pseudopolyps. [ncbi.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 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]

  A low red blood cell count can indicate anemia, from bleeding within the colon and rectum. Elevated white blood cells, which fight infection, indicate inflammation within the colon and rectum. [virginiamason.org]

• Chills

  Vedolizumab Infections, hypersensitivity reactions, common colds Ustekinumab Injection site reactions (pain, redness, swelling), cold-like symptoms, chills, headache, tired feeling, diarrhea, lower back pain, painful urination, or rash or itching This [msdmanuals.com]

  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]

• 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]

  (especially during defecation) rectal bleeding anemia (iron deficiency) due to blood loss in diarrhea urgency to defecate (urgent bowel movements) or incontinence (loss of bowel control) weight loss or other signs of malnutrition (e.g., tiredness or malaise [medbroadcast.com]

  Systemic symptoms and signs, more common with extensive ulcerative colitis, include malaise, fever, anemia, anorexia, and weight loss. [merckmanuals.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]

• Diarrhea

  When to see a doctor See your doctor if you experience a persistent change in your bowel habits or if you have signs and symptoms such as: Abdominal pain Blood in your stool Ongoing diarrhea that doesn't respond to over-the-counter medications Diarrhea [mayoclinic.org]

  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]

  Although specific foods do not cause the disease, some types of food may trigger discomfort and diarrhea. Spicy or high-fiber foods may need to be eliminated especially when the diarrhea phase is active. [emedicinehealth.com]

• 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]

  In addition to bloody diarrhea and abdominal pain on the left side, a patient may also experience weight loss. [self.com]

• 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]

  Gross rectal bleeding is rare, except in 75‒85% of cases of Crohn colitis. Gross rectal bleeding is always present. Fistula, mass, and abscess development is common. Fistulas do not occur. Perianal lesions are significant in 25‒35% of cases. [msdmanuals.com]

  Signs and symptoms may include: Diarrhea, often with blood or pus Abdominal pain and cramping Rectal pain Rectal bleeding — passing small amount of blood with stool Urgency to defecate Inability to defecate despite urgency Weight loss Fatigue Fever In [mayoclinic.org]

• Nausea

  Aminosalicylates Sulfasalazine Common: Nausea, headache, dizziness, fatigue, fever, rash, and, in men, reversible infertility Uncommon: Inflammation of the liver (hepatitis), pancreas (pancreatitis), or lung (pneumonitis) and hemolytic anemia Abdominal [msdmanuals.com]

  The symptoms of ulcerative colitis are typically abdominal pain, nausea for some people, cramping in the gut, and diarrhoea. [healthengine.com.au]

  Symptoms of ulcerative colitis include: Bloody diarrhea Abdominal pain Nausea Vomiting Loss of appetite Weight loss Fever Fatigue Prevalence of ulcerative colitis According to the GI Society, approximately 104,000 Canadians are living with ulcerative [quibd.com]

  Four patients receiving nicotine discontinued therapy because of side effects (contact dermatitis [n = 2], nausea [n = 1], and acute pancreatitis [n = 1]). [ncbi.nlm.nih.gov]

• 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]

  Symptoms of ulcerative colitis include: Bloody diarrhea Abdominal pain Nausea Vomiting Loss of appetite Weight loss Fever Fatigue Prevalence of ulcerative colitis According to the GI Society, approximately 104,000 Canadians are living with ulcerative [quibd.com]

  Other symptoms include wind, loss of appetite, weight loss, fever and fatigue. Currently, there is no cure for the condition apart from surgery. [news-medical.net]

• Tachycardia

  Although the patient received percutaneous cardiopulmonary support, his EF progressively decreased (7-15%), and both ventricular tachycardia (VT) and high-degree atrial-ventricular block occurred. [ncbi.nlm.nih.gov]

  Other warning signs of potentially severe disease include tachycardia, fever and anaemia. [patient.info]

  4] Signs and symptoms[edit] External signs and symptoms are constipation of very long duration, abdominal bloating, abdominal tenderness and tympany, abdominal pain, palpation of hard fecal masses and, in toxic megacolon, fever, low blood potassium, tachycardia [en.wikipedia.org]

  Patients with > 10 bloody bowel movements per day, tachycardia, high fever, or severe abdominal pain require hospitalization to receive high-dose IV corticosteroids. 5-ASA may be continued. [merckmanuals.com]

• 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]

  The band’s website had this statement: “Glenn fought a courageous battle for the past several weeks but, sadly, succumbed to complications from rheumatoid arthritis, acute ulcerative colitis and pneumonia.” [lifezette.com]

  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]

• 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]

  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]

• Anterior Uveitis

  Ophthalmological examination established the diagnosis of anterior uveitis. Inflammatory markers were positive. Histological examination of skin lesions revealed a dense neutrophilic infiltrate of the dermis. [ncbi.nlm.nih.gov]

  Anterior uveitis. Not related to activity of colitis: Sacroiliitis. Ankylosing spondylitis. Primary sclerosing cholangitis. Differential diagnosis The main differential is Crohn's disease which has very similar clinical features. [patient.info]

• Blurred Vision

  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]

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]

• Nephrolithiasis

  complicated urinary tract infection Left low back pain Spleen Kidney: kidney stone (nephrolithiasis), complicated urinary tract infection Low back pain kidney pain (kidney stone, kidney cancer, hydronephrosis) Ureteral stone pain Pathophysiology[edit [en.wikipedia.org]

• Pneumoperitoneum

  […] patients (27%) The serum bicarbonate level was less than 24 mmol/L in 26 patients (36%) Plain X-rays are often normal or show non-specific findings. [25] In a series of 73 patients, plain abdominal radiography (56%) showing colic distension in 53% or a pneumoperitoneum [en.wikipedia.org]

• 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]

  Other possible laboratory abnormalities include leukocytosis, thrombocytosis, and elevated acute-phase reactants (eg, erythrocyte sedimentation rate, C-reactive protein). X-rays are not diagnostic but occasionally show abnormalities. [msdmanuals.com]

  ] Diagnosis[edit] H&E stain of a colonic biopsy showing a crypt abscess, a classic finding in ulcerative colitis The initial diagnostic workup for ulcerative colitis includes the following:[14][38] A complete blood count is done to check for anemia; thrombocytosis [en.wikipedia.org]

• 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

  Surveillance colonoscopy program demonstrated its efficacy for reducing the incidence of colorectal cancer in ulcerative colitis. [ncbi.nlm.nih.gov]

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

  What is ulcerative colitis? Crohn's and Colitis Foundation of America. http://www.crohnscolitisfoundation.org/what-are-crohns-and-colitis/what-is-ulcerative-colitis/. Accessed June 20, 2017. Ulcerative colitis. [mayoclinic.org]

• Colonic Ulcer

  Ulcerative colitis is a disease that causes ulcers in the lining of the rectum and colon. It is one of a group of diseases called inflammatory bowel disease. Ulcers form where inflammation has killed the cells that usually line the colon. [icd9data.com]

  What is Ulcerative Colitis? Ulcerative colitis is a disease of the large intestine (colon) that causes inflammation and sores (ulcers), which produce pus and mucous. This can cause stomach discomfort and rapid emptying of your colon (diarrhea). [stanfordhealthcare.org]

  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 [uclahealth.org]

  Individuals who have ulcerative colitis may have an increased risk of developing colon cancer. [doi.org]

• Multiple Ulcerations

  Active duodenal ulcer was found using gastroscopy. 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]

  Although multiple factors have been shown to influence medication adherence in patients with ulcerative colitis it is commonly believed that a high pill burden and multi‐dose regimens are major determinants ( Ediger 2007 ; Kane 2008 ). [doi.org]

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.

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.

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.

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.

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.

There are no guidelines for prevention of ulcerative colitis.

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.

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.

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.