Your Online Health Information Site

Advertisement

Ulcerative Colitis

Introduction

Ulcerative colitis is another inflammatory bowel disease, but contrary to Crohn’s disease ulcerative colitis is only confined to the large intestine and the rectum. Ulcerative colitis always leads to bloody diarrhea.

There are no perianal or other fistulas associated with it. There is no known cause for ulcerative colitis. The main pathological lesions are micro abscesses and ulcerations in the mucosa lining of the colon, which can occur from the rectum just inside the anal ring all the way up to the ileocecal valve (thanks to www.medicalook.com for the image).

Ulcerative colitis

Ulcerative colitis

These ulcerations develop in mucosa where prior damage had occurred with infiltration of the deeper layers of the mucosa with inflammatory cells and a closing of the sub-epithelial capillaries.

It is unknown why these changes occur, but without blood supply these ulcerations happen. This pathological process starts in the rectum and sigmoid colon area, which is the lower end of the large intestine. From there it has a tendency to progress slowly upwards into the descending (on the left abdomen), the transverse (crossing the top of the abdomen) to the ascending colon (located in the right abdomen). However, in a small percentage of patients with a more benign form of ulcerative colitis it stays confined to the rectum.

Symptoms of Ulcerative Colitis

The first sign might be some mild lower or left abdominal pain. This is followed by an urgency to defecate and the passing of blood and mucous in the stools. Eventually diarrhea with blood in it will develop. Occasionally a severe attack might develop with high fever, acute abdominal spasms, acute, bloody diarrhea, signs of peritonitis and a toxic appearance. The physician must sort out whether there is another overlying bacterial or parasitic colitis, whether this is only a bad bout of ulcerative colitis, or whether there is one of the complications listed below that is presenting itself. Several tests may have to be done to help the physician to diagnose the condition properly.

 

References:

1. M Frevel Aliment Pharmacol Ther 2000 Sep (9): 1151-1157.

2. M Candelli et al. Panminerva Med 2000 Mar 42(1): 55-59.

3. LA Thomas et al. Gastroenterology 2000 Sep 119(3): 806-815.

4. R Tritapepe et al. Panminerva Med 1999 Sep 41(3): 243-246.

5. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapters 20,23, 26.

 6. EJ Simchuk et al. Am J Surg 2000 May 179(5):352-355.

 7. G Uomo et al. Ann Ital Chir 2000 Jan/Feb 71(1): 17-21.

 8. PG Lankisch et al. Int J Pancreatol 1999 Dec 26(3): 131-136.

 9. HB Cook et al. J Gastroenterol Hepatol 2000 Sep 15(9): 1032-1036.

10. W Dickey et al. Am J Gastroenterol 2000 March 95(3): 712-714.

11. M Hummel et al. Diabetologia 2000 Aug 43(8): 1005-1011.

12. DG Bowen et al. Dig Dis Sci 2000 Sep 45(9):1810-1813.

13. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse  Station, N.J., 1999.Chapter 31, page 311.

14. O Punyabati et al. Indian J Gastroenterol 2000 Jul/Sep 19(3):122-125.

15. S Blomhoff et al. Dig Dis Sci 2000 Jun 45(6): 1160-1165.

16. M Camilleri et al. J Am Geriatr Soc 2000 Sep 48(9):1142-1150.

17. MJ Smith et al. J R Coll Physicians Lond 2000 Sep/Oct 34(5): 448-451.

18. YA Saito et al. Am J Gastroenterol 2000 Oct 95(10): 2816-2824.

19. M Camilleri Am J Med 1999 Nov 107(5A): 27S-32S.

20. CM Prather et al. Gastroenterology 2000 Mar 118(3): 463-468.

21. MJ Farthing : Baillieres Best Pract Res Clin Gastroenterol 1999 Oct 13(3): 461-471.

22. D Heresbach et al. Eur Cytokine Netw 1999 Mar 10(1): 7-15.

23. BE Sands et al. Gastroenterology 1999 Jul 117(1):58-64.

24. B Greenwood-Van Meerveld et al.Lab invest 2000 Aug 80(8):1269-1280.

25. GR Hill et al. Blood 2000 May 1;95(9): 2754-2759.

26. RB Stein et al. Drug Saf 2000 Nov 23(5):429-448.

27. JM Wagner et al. JAMA 1996 Nov 20;276 (19): 1589-1594.

28. James Chin, M.D. Control of Communicable Diseases Manual. 17th ed., American Public Health Association, 2000.

29. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 157, page1181.

30. Textbook of Primary Care Medicine, 3rd ed., Copyright © 2001 Mosby, Inc., pages 976-983: “Chapter 107 – Acute Abdomen and Common Surgical Abdominal Problems”.

31. Marx: Rosen’s Emergency Medicine: Concepts and Clinical Practice, 5th ed., Copyright © 2002 Mosby, Inc. , p. 185:”Abdominal pain”.

32. Feldman: Sleisenger & Fordtran’s Gastrointestinal and Liver Disease, 7th ed., Copyright © 2002 Elsevier, p. 71: “Chapter 4 – Abdominal Pain, Including the Acute Abdomen”.

33. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.

34. Suzanne Somers: “Breakthrough” Eight Steps to Wellness– Life-altering Secrets from Today’s Cutting-edge Doctors”, Crown Publishers, 2008

Last modified: August 26, 2014

Disclaimer
This outline is only a teaching aid to patients and should stimulate you to ask the right questions when seeing your doctor. However, the responsibility of treatment stays in the hands of your doctor and you.