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Ulcerative colitis is a chronic inflammatory disease of the colon.

The inflammation tends to be progressively more severe from proximal to distal colon.

CLINICAL FEATURES

• Mild : these patients have fewer bowel movements and fewer systemic symptoms and few extra intestinal manifestation. Occasionally constipation and rectal bleeding is only complaint.
• Moderate: these patients usually have colitis extending upto splenic flexure but may develop pancolitis.
• Severe : it is associated with frequent bowel movements, anemia, fever, weight loss, low serum albumin, and more manifestation. Virtually all severely affected patients have pancolitis.

EXTRA INTESTINAL MANIFESTATION

• ARTHRITIC
  • Peripheral arthritis.
  • Ankylosing spondylitis.
  • Sacrolitis.
• OCULAR
  • Episcleritis
  • Uveitis
• DERMATOLOGIC
  • Erythema nodosum
  • Pyoderma gangrenosum
• HEPATOBILIARY
  • Cholelithiasis
  • Fatty liver
  • Pericholangitis
  • Chronic active hepatitis.
  • Primary scelrosing cholangitis
  • Cholangiocarcinoma
  • Pancreatitis.
• VASCULITIS
  • Thromboembolic disease
• OTHER
  • Malnutrition.
  • Chronic anemia.
  • Nephrolithiasis

DIAGNOSIS

• Leucocytosis, anemia, thrombocytopenia.
• Decreased serum albumin and abnormal liver function .
• Abdominal CT scanning.
• Biomarkers: Anti- sacchromyces cerevisiae antibodies & perinuclear antineutrophil cytoplasmic antibodies are both sensitive and specific.

COMPLICATION

• TOXIC MEGACOLON:

• Toxic megacolon develops in advance case of colitis when the disease process begins to extend through all layers of the colon. The result is loss of muscular tone within the colon , within the colon , with dilatation and localised peritonitis.
• Plain x ray demonstrates a long , continous segemnt of air filled colon >6cm in diameter.
• The distended portion of the atonic colon can perforate causing peritonitis, septicemia.
• Clinical feature: abdomen distended , tender, tympantic, severe diarrhea, fever , tachycardia, and signs of hypovolemia .

• Perirectal fistula.
• Abscess.
• Massive GI Heamorrahage
• Acute perforation
• Ca colon colon.

TREATMENT

ACTIVE PROCTITIS

• Mesalazine enemas or suppositories combined with oral mesalazine are effective first line of therapy.

• Topical corticosteroids are less effective and are reseved for patients who are not tolerating mesalazine . Patients who fail to respond are treated with oral prednisoline 40mg daily.

ACTIVE LEFT SIDED or Extensive ulcerative colitis.

• High dose aminosalicylate combined with topical aminosalicylate and corticosteroid are effective..

• Oral prednisolone 40 mg are indicated for more active disease or when initial aminosalicylate is ineffective.

SEVERE ULCERATIVE COLITIS

• correct dehydration and nutritional support , usually as enteral.
• IV corticosteroids are used .
• Topical and oral aminosalicylates are used.

MAINTENANCE OF REMISSION:

• Life long therapy with mesalazine or balsalazide are first line agents.