View Full Version : ULCERATIVE COLITIS(Etiology-Pathology-Clinical picture-Complications-Investigations-Treatment)

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05-03-2008, 05:15 AM
m Incidence: Uncommon in Egypt. Male : Female = 1 : 2
m Aetiology: Unknown but may be due to:
1- Psycho-somatic disturbance.
2- Auto-immune disease.
3- Viral or bacterial infection.
m Pathology:
· It affects the whole colon and rectum.
· The main lesion is multiple superficial ulcers.
· The mucosa between ulcers is inflammed ® deep red colour and oedematous ® pseudopolypi.
· The ulcers heal by fibrosis ® shortening of the colon and loss of its haustration.
· If biopsy taken from mucosa after healing it will show loss of typical glandular pattern of mucosa.
m Clinical Picture: 3 clinical types are present:
1- Acute fulminating type : (Fatal type)
· The whole colon is affected giving severe diarrhea, tenesmus massive bleeding / rectum.
· Great toxaemia occur due to toxic absorption.
· The patient will die from ® shock, toxaemia or perforation® peritonitis.
· Fortunately it is not common 5 : 10% of cases.
2- Chronic intermittent type:Characterised by remissions and exacerbations.
· The attacks are limited.
· Periods of remissions are long.
· It is the commonest type met with in practice.
3- Chronic continuous type:
· The symptoms persist but vary in severity.
· Marked loss of weight.
· The patient is usually disturbed psychologically.
· This type may turn malignant.
m Complications:
1- Hemorrhage, perforation, fistula formation.
2- Stricture ® intestinal obstruction.
3- Malignant change (5:10%) (only in chronic continuous type).
1- Anaemia & hypoprotenaemia due to diarrhea and bleeding / rectum.
2- Chronic toxaemia and toxic megacolon due to toxic absorption.
3- Iridocyclitis, arthritis and skin ulcerations due to deposition of immune complexes.

m Investigations:
1- Barium enema during remission: loss of haustration
2- Colonoscopy: Detect lesions in exacerbation periods and if biopsy is taken during remission ® loss of glandular pattern of the mucosa.
m Treatment:
(I) Conserevative treatment:
- Diet: low residue, avoid milk and its products.
- Intestinal antiseptic ® salazopyrene.
- Short courses of corticosteroids and cortisone enema. But it may percipitate hge. or perforation.
- Correction of anaemia and psychotherapy.

(II) Surgical treatment:

- indications: * Fulminating type.
* Complicated cases.
1- The operation is " Total coloproctectomy" with terminal ileostomy.
2- Some surgeons prefer colectomy only with ilioproctostomy with observation of rectal stump.
3- Ilio-anal anastomosis with pouch can be performed but it needs great skill.
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