Ulcerative colitis
An inflammatory condition that affects the surface of the colon, ulcerative colitis causes friability and erosions with bleeding. The disease usually begins in the rectal area and may extend through the entire bowel. Less frequently, it extends into the splenic flexure, or more proximally extends upward into the entire colon. It rarely affects the small intestine, except for the terminal ileum.
Severity ranges from a mild, localized disorder to a fulminant disease that may lead to a perforated colon, progressing to peritonitis and toxemia.
Causes
Although the etiology of ulcerative colitis is unknown, it’s thought to be related to an autoimmune response. Stress is no longer thought to be a cause. However, it may precipitate or increase the severity of the attack.
Ulcerative colitis occurs primarily in young adults, especially women; it’s also more prevalent among the Jewish population and individuals in higher socioeconomic groups. Onset of symptoms seems to peak in the 15- to 30-year-old age-group, with another peak occurring in the 50- to 70-year-old age-group.
Signs and symptoms
The hallmark of ulcerative colitis is bloody diarrhea. The intensity of these attacks varies with the extent of inflammation. Patients with mild to moderate disease may experience five or fewer bowel movements per day with intermittent bleeding and mucus production. Individuals may experience left lower quadrant pain relieved by defecation, along with fecal urgency and tenesmus. Patients with more severe disease will have more than five bowel movements per day, which may result in anemia, hypovolemia, and impaired nutrition. Extracolonic manifestations also may be present, including erythema nodosum, pyoderma gangrenosum, episcleritis, thromboembolic events, and arthritis.
Ulcerative colitis may lead to complications affecting the following organs and systems:
Blood: anemia from iron deficiency, coagulation defects due to vitamin K deficiency
Skin: erythema nodosum on the face and arms; pyoderma gangrenosum on the legs and ankles
Eye: uveitis
Liver: pericholangitis, sclerosing cholangitis, cirrhosis, possible cholangiocarcinoma
Musculoskeletal: arthritis, ankylosing spondylitis, loss of muscle mass
GI: strictures, pseudopolyps, stenosis, and perforated colon, leading to peritonitis and toxemia.
Clinical TipThe risk of colorectal cancer in patients who have had ulcerative colitis for more than 10 years increases by approximately 1% per year. Also, patients with disease proximal to the sigmoid colon have an increased risk of developing colon carcinomas.
Diagnosis
History and physical examination should include questions regarding frequency of stools, rectal bleeding, cramps, abdominal pain, weight loss, and tenesmus. Peritoneal inflammation should be assessed, as well as volume status and nutritional levels.
