Disease ulcerative colitis

AROUND 100,000 HAVE THIS DISASE IN UK

CURRENT HYPOTHESIS ,

HIGHER CONCORDANCE RATE IN MONOZYGOTIC TWINS

ULCERATIVE COLITIS 

Ulcerative colitis is a inflammatory disease which involves the whole part of the colon .The inflammation is initially confined to the mucosa and nearly always involves the rectum .extending to involve the distal or whole colon.In severe cases the inflammation may extend into the muscle coats .Acute complications include toxic dilatation , haemorrhage and perforation .

AETIOLOGY 

The cause of ulcerative colitis is not known.Current hypotheses includes immunological ,dietary and genetic factors .Familial clustering occurs . There is an association with HLA-DR2.Other evidence of a genetic role includes a higher concordance rate in monozygotic twins  ,and increased prevalence in certain ethnic groups and an association with disease that are known to have a genetic predisposition .e.g ankylosing spondylitis and sclerosing cholangitis . Immunological mechanism may be important .Under normal circumtances the mucosal immune system is tolernt of luminal forign antigens and this is dependent upon the relationship between colonic epithelium and suppressor T cells .

Changes in epithelial cell antigen presentation consequent upon an acquired expression of class II major histocompatibility mlecules activate helper T lymphocytes and induce a sustained mucosal immune reaction .Antigens from gut flora may be responsible for this .This may explain the well-known triggering of ulcerative colitis by enteric infections. Dietary factors may also provide a triggering factor.

MORPHOLOGY ulcerative colitis is a diffuse inflammatory disease confined initially to the mucosa.Unlike Crohn's disease it is confined to the large intestine and is continuous in its distribution.In some cases it is confined to the rectum ( proctitis ) ,or to the rectosigmoid (distal proctitis ).

Abcesses form in the crypts of Lieberkuhn ,penetrate the superficial mucosa ,spread horizontally and cause the overlying mucosa to slough.The margins of the ulcers are raised as mucosal tags that project into the lumen ( inflammatory pseudopolyps ) Except in the most seere forms the muscle layers are spared .Occasionally the last few centimeters o the terminal ileum is ulcerated ,i.e the so called condition of 'backwash ' ileitis .

CLINICAL FEATURES  More common in women ,aged 3rd ,4th and 2nd decade ,in that order .

SYMPTOMS

IN CHRONIC TYPE initially watery diarrhea occuring day and night ,in a person of previously normal bowel habit.Later a rectal discharge of mucus ,sometimes blood stained and purulent is very common .Severe bloody diarrhea upto 20 times daily may occur .pain is unusual ,initially,relases and remissions.

IN ACUTE FULMINATING TYPE

Incessant diarrhea containing blood ,mucus and pus .fever Abdominal distension ( due to toxic dilatation of colon ) ,Abdominal pain

SIGNS

IN CHRONIC TYPE depending upon severity of attacks dehydration ,Anemia

IN ACUTE FULMINATING TYPE pyrexia ,100-102 F .dehydration ,anemia and abdominal distension.

ULCERATIVE COLITIS 

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SYMPTOMS

DIAGNOSIS

TREATMENT

SURGERY

COMPLICATIONS