7. ULCERATIVE COLITIS
Ulcerative colitis (Colitis ulcerosa, UC) is a form of
inflammatory bowel disease (IBD).
Ulcerative colitis is a form of colitis, a disease of the
intestine, specifically the large intestine or colon, that
includes characteristic ulcers, or open sores, in the
colon.
The main symptom of active disease is usually
diarrhea mixed with blood, of gradual onset.
however, a systemic disease that affects many parts
of the body outside the intestine
8.
9. AETILOGY
Exact cause is unknown.
Several causes have been suggested .it
includes
1. Genetic Factors
2. Environmental Factors
3. Auto Immune Disease
4. Several Other Theories
10. Genetic factors
A genetic component to the etiology of ulcerative
colitis can be hypothesized based on the
following
1. Aggregation of ulcerative colitis in Families.
2. Diet: as the colon is exposed to many different
dietary substances which may encourage
inflammation.
3. Other childhood exposures or infections
11. Autoimmune disease
4. Some sources list ulcerative colitis as an
Autoimmune disease
Disease in which immune system malfunctions,
attacking some parts of body.
This suggests cause of disease is in colon itself,
not in immune system.
12. Pathological Feature
Ulcerative colitis involves only the mucosa; it is
characterized by the formation of crypt abscesses and a
coexisting depletion of goblet cell mucin.
In severe cases, the submucosa may be involved; in
some cases, the deeper muscular layers of the colonic
wall is also affected.
Increased cellular infiltrate in the lamina propria,more
extensive and extends diffusely towards the deeper part
(transmucosal)
Accumulation of plasma cells near the mucosal base, in-
between the crypt base and the muscularis mucosae (basal
plasmacytosis
13. An irregular surface or a villiform surface and a disturbed
crypt architecture.
Mucosal atrophy characterized by a combination of crypt
drop-out and shortening of crypts.
Mucosal ulcerations and erosions, mucin depletion,
Paneth-cell metaplasia and diffuse thickening of the
muscularis mucosae
14. H&E stain of a colonic biopsy showing a crypt
abscess:a classic finding in ulcerative colitis
15.
16.
17. Patients with ulcerative colitis
can occasionally have
aphthous ulcers involving the
tongue, lips, palate and
pharynx
Endoscopic image of ulcerative colitis
showing loss of vascular pattern of the
sigmoid colon, granularity and some
friability of the mucosa.
18. CLASSIFICATION
Extent of involvement
The disease is classified by the extent of involvement,
depending on how far up the colon the disease extends.
1.Distal colitis
a. Proctitis: Involvement limited to the rectum.
b. Proctosigmoiditis: Involvement of the rectosigmoid colon, the
portion of the colon adjacent to the rectum.
c. Left-sided colitis: Involvement of the descending colon, which runs
along the patient's left side, up to the splenic flexure and the
beginning of the transverse colon.
2.Extensive colitis, inflammation extending beyond the
reach of enemas:
19. 1. Mild disease : fewer than 4 stools daily,no signs of
systemic toxicity,normal ESR,mild abdominal pain.
2. Moderate disease :more than 4 stools daily,minimal
signs of toxicity,anaemia,moderate abdominal
pain,low grade fever.
3. Severe disease :more than 6 bloody stools,evidence
of toxicity with fever,tachycardia,elevated ESR
4. Fulminant disease :more than 10
stools,bleeding,toxicity,abdominal tenderness,blood
transfusion requirement.unless treated will lead to
death.
Severity of disease
20. Clinical presentation
1. Diarrhoea mixed with blood and mucus.
2. Gradual onset.
3. Signs of weight loss.
4. Different degrees of abdominal pain ranging
from mild discomfort to severely painful
cramps.
21. Extraintestinal features
1. Iritis
2. Episcleritis
3. Aphthous ulcers involving
tongue,lips,palate,pharynx.
4. Arthritis
5. Ankylosing spondylitis
6. Erythema nodusum
7. Deep venous thrombosis
8. Pulmonary embolism
9. Auto immune hemolytic anaemia
10. Clubbing of fingers
22. Diagnosis
1. Complete blood count-
anaemia,thrombocytosis,high platelet count.
2. Electrolyte studies-hypokalemia,hypomagnesia
3. Renal function tests
4. Liver function tests
5. X-ray
6. Stool culture
7. ESR
8. C-reactive protein
24. Definition:Definition:
Crohn's disease (also known as regional
enteritis) is a chronic, episodic, inflammatory
condition of the gastrointestinal tract characterized
by:
Transmural inflammation (affecting the entire wall
of the involved bowel) and skip lesions (areas of
inflammation with areas of normal lining between).
Crohn's disease is a type of inflammatory bowel
disease (IBD) and can affect any part of the
gastrointestinal tract from mouth to anus; as a
result,
25. Introduction to Crohn’s disease:
This is a chronic inflammatory disease which causes
stomach pains, diarrhoea, and weight loss.
The disease is characterised by periods of activity and
remissions.
It typically affects the lower part of the small intestine (ileum)
or the large intestine (colon), but it can affect any part of the
digestive system.
28. Cause
The exact cause of Crohn's disease is unknown.
However, genetic and environmental factors
have been invoked in the pathogenesis of the
disease.
Mutations in the CARD15 gene (also known as
the NOD2 gene) are associated with Crohn's
disease and with susceptibility to certain
phenotypes of disease location and activity.
29. Cause contd..
Abnormalities in the immune system
Many environmental factors.
Diets
Smoking
Methods of hormonal contraception
Some bacteria:
Eg Mycobacterium avium subsp. Paratuberculosis,
mannose, anti saccharomyces cerevisiae antibodies
and E. coli
30. Pathology:
Odeomatous and thickened bowel wall
Cobblestone
Patchy inlammation
Skip lessions
Transmural inflammation
Mucosal damage (transmural)
Well demarcated regions
Noncaseating granulomas
Formation of fissures
narrowed lumen (obstruction)
H and E section of colectomy showing transmural inflammation.
34. Clinical Features
Ileal Crohn’s Disease
Abdominal pain
Diarrhea
Weight loss
Crohn’s colitis
Bloody diarrohea
Passage of mucus
Lethargy
Malaise
Anorexia
Weight loss
35. Chronic course may lead to:
Fibrosing strictures
- terminal ileum
- fistulas other areas
Protein loss
Vit B12 loss
Bile salt loss
- steatorrhea
Complications:
38. Contd…..
Bacteriology
Barium studies
Other investigations
X-ray
Radio labelled white cell scan
Ultrasound
MRI scans
39. Contd..
CT scan showing Crohn's disease in the fundus of the stomach.
40. ULCERATIVE
COLITIS
CROHN’S
Age Any Any
Sex m=f M=f
Anatomical
distribution
Colon only Any part of G.I
Presentation Bloody
diarrhoea
Variable; pain diarrhoea,
Weight loss
Risk factors more common in
non smokers
More common in smokers
Comparison of UC and CD
45. Drug Therapies
5-Aminosalicylates (5-ASA): Aminosalicylates are
A group of medicines that can help to control the symptoms
of some inflammatory bowel (gut) diseases.
Glucocorticoids (steroids)
Antibiotics
Immunosuppressants
Biological Therapy
46. Aminosalicylates
Sulfasalazine (5-aminosalicylic acid and
sulfapyridine as carrier substance)
Mesalazine (5-ASA), e.g. Asacol, Pentasa
Balsalazide (prodrug of 5-ASA)
Olsalazine (5-ASA dimer cleaves in colon)
Oral, rectal preparation
47. What is Irritable Bowel Syndrome(IBS)?
A group of functional bowel disorders
Chronic abdominal complaints without a structural or
biochemical cause
Constitutes a major health problem with gastrointestinal
(GI) symptoms
The cause of IBS is unknown.
Affects up to ~20 % adults in the industrialized world
The condition is more frequent in women.
The direct medical costs of IBS are ~ $ US 8 billion in the
US each year.
48. Clinical Manifestation
Usually affects individuals younger than 45.
Decreased incidence in older individuals
Women are 2-3 times more likely to have IBS.
[80% patients are women]
49.
50. Findings
The main finding is abdominal pain during morning
hours – which may be in the hypogastrium (25%),
right (20%), left (20%), and epigastrium (10%).
Other findings may include defecation straining,
urgency or a feeling of incomplete bowel movement,
bloating, and passing mucus.
Crohn's disease shows a transmural pattern of inflammation, meaning that the inflammation may span the entire depth of the intestinal wall.[1]
Slide 5
Ideally, treatment for active Crohn's disease should rapidly improve symptoms.
Non-specific anti-inflammatory drugs are the mainstay of treatment for Crohn's disease. Examples are:
glucocorticoids
5-aminosalicylates (5-ASA)
immunosuppressants
antimetabolites
methotrexate.