Ulcerative Colitis | Causes, Symptoms and Treatment of Ulcerative Colitis
What is Ulcerative Colitis
Ulcerative colitis is defined as inflammatory disease of unknown origin characterized clinically by recurrent attacks of bloody diarrhea and pathologically by diffuse inflammation of colonic mucosa.
Causes of ulcerative colitis
It is seen in age group of 20-40yrs and more in females.
Cause if unknown.
Possible factors associated with ulcerative colitis include
- Genetic prevalence- increased incidence is seen in certain families.
- Immunological.
- Psychological factors may influence the cause of disease but not cause it.
- Most patients are non-smokers and this raises the possibility of protective role of smoking.
Symptoms of Ulcerative Colitis
A. Acute
Acute attack may be mild, moderate or severe.
Passage of frequent, small volume loose stools with fresh blood and mucus is present.
Abdominal cramps with moderate attacks of pain are seen.
Rectal pain, tenesmus with fever in severe attack is present.
B. Chronic
General symptoms- low grade fever, malaise, anorexia, weight loss.
Gastrointestinal symptoms- insidious onset with diarrhea and/or subsequent passage of blood and mucus. Tenderness over affected colon.
Symptoms due to nutritional deficiency- anemia, hypoprotinemia.
Extra-intestinal symptoms- apthous ulcers, erythema nodosum and conjunctivitis.
Complications of Ulcerative Colitis
- Toxic dilatation, perforation and massive hemorrhage.
- Cancer of colon.
- Arthropathy tending to affect large weight bearing joints.
Investigations for Ulcerative Colitis
1. Stools examination to exclude ameobiasis.
2. Sigmoidoscopy and rectal biopsy
The appearance on the above can be graded as-
- Mild- showing hyperemia and edema.
- Moderate- showing granular mucosa with contact bleeding.
- Severe- showing ulceration and spontaneous bleeding.
3. Barium enema
In ulcerative colitis barium enema shows diminished length, caliber and distensibility of colon.
Superficial ulceration and absence of normal mucosal pattern in evacuation films is seen.
4. Colonoscopy
It is not necessary for diagnosis but may be required to establish nature of structuring or polypoid lesions seen radiologically.
Treatment for Ulcerative Colitis
Medical treatment
1. General measures
- Bed rest.
- Correction of dehydration and electrolyte loss with intravenous (IV) infusions of saline or dextrose with added potassium.
- Correction of anemia.
2. Symptomatic treatment
- Codeine phosphate for diarrhea.
- Oral iron if patient can tolerate for anemia.
- General psychological support.
Surgery for Ulcerative Colitis
Indications for surgery are
- No improvement in patient’s condition after reasonable trial of medical treatment.
- Perforation of colon.
- Acute dilatation of colon.
- Massive hemorrhage from bowel.
- Complications like fistula in ano or recto-vaginal fistula.
- Carcinoma colon.
Surgery usually involves pancolectomy as a two stage (with intervening colostomy) or a one stage procedure.
The ileum is anastomosed to anal canal or muscular cuff of rectum either directly or with a retaining pouch.
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