ulcerative colitis, classification, causes,clinical features, morphology, differential diagnosis...
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IBD
Ulcerative Colitis
Lecture 13 By Dr Mohammad Manzoor
Ulcerative Proctosigmoiditis
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Ulcerative Colitis• Ulcerative Colitis is an ulceroinflammatory
disease affecting the colon, which is limited to the mucosa and submucosa, except in the most severe cases.
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UC• It begins in the rectum and extends
proximally in a continuous fashion sometimes involving the entire colon (Pancolitis).
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Epidemiology
• More common in USA & Western countries. The incidence has risen in recent decades. More common among whites. Females are affected slightly more. A peak incidence between ages 20-25 years. Has a familial association.
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Morphology• Gross:• Rectum & Sigmoid --may involve entire colon.• The lesions are continuous.• inflammatory destruction of the mucosa with
macroscopic appearance of :• Hyperemia, edema, and granularity with
friability and easy bleeding.
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Morphology• With severe active disease:• Extensive and broad based ulceration in the distal
colon.• Pseudopolyps• Toxic megacolon
Pseudopolyps are projecting masses of scar tissue that develop from granulation tissue during the healing phase in repeated cycle of ulceration (especially in inflammatory bowel disease).
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Morphology• A diffuse, predominantly mononuclear
inflammatory infiltrate in the lamina propria and Crypt abscesses.
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Complications:• Perforation,
• peritonitis,
• abscess
• Toxic megacolon
• Venous thrombosis
• Carcinoma
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Clinical features• Bloody mucoid diarrhea• Cramps ( a painful & involuntary muscular contraction)
• Tenesmus (painful spasm of the anal sphincter along with the urgent desire to defecate without the significant production of feces)
• Colicky lower abdominal pain• Fever • Weight loss
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Extra-intestinal symptoms
• Migratory polyarthritis, • Sacroilitis, • Ankylosing spondilitis, • Uveitis, • Erythema nodosum and • Hepatic involvement (pericholangitis and• Primary sclerosing (cholangitis).
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Diagnosis•Endoscopy•Biopsy
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Comparison of CD &UC• Crohn disease and ulcerative colitis differ in
many respects, including the natural history of the disease, pathological aspects, and in the types of therapies and responses to treatment.
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Comparisons of various factors in Crohn's disease and ulcerative colitis
Crohn's Disease Crohn's Disease Ulcerative Colitis Ulcerative Colitis
Involves terminal ileum Involves terminal ileum Commonly Commonly Seldom Seldom
Involves colon? Involves colon?
Involves rectum? Involves rectum?
Usually Usually
Seldom Seldom
Always Always
Usually Usually
Bile duct involvement? Bile duct involvement? Not associated Not associated Higher rate of Primary Higher rate of Primary sclerosing cholangitis sclerosing cholangitis
Distribution of Disease Distribution of Disease Patchy areas of Patchy areas of inflammation inflammation
Continuous area of Continuous area of inflammation inflammation
Endoscopy Endoscopy Linear and serpiginous Linear and serpiginous (snake-like) ulcers (snake-like) ulcers
Continuous ulcer Continuous ulcer
Depth of inflammation Depth of inflammation May be transmural, deep May be transmural, deep into tissues into tissues
Shallow, mucosal Shallow, mucosal
Sometimes
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FistulaeFistulae, , abnormal abnormal passageways between passageways between
organs organs
Commonly Commonly Seldom Seldom
Biopsy Biopsy Can have Can have granulomagranulomata ta Crypt abscesses and Crypt abscesses and cryptitis cryptitis
Surgical cure ?Surgical cure ?
Smoking Smoking
Often returnsOften returns following removal of following removal of
affected part affected part
Higher risk for smokers Higher risk for smokers
Usually cured by Usually cured by removal of colon, removal of colon,
Lower risk for smokers Lower risk for smokers
Autoimmune disease Autoimmune disease Generally regarded as Generally regarded as an autoimmune an autoimmune
disease disease
No consensus No consensus
Cancer risk? Cancer risk? Lower than ulcerative Lower than ulcerative colitis colitis
Higher Higher than Crohn's than Crohn's
Comparisons of various factors in Crohn's disease and UC (Cont.)
Lymphoma Carcinoma
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Features UC CD
Morphologic
Distribution Diffuse,mucosal &submucosal, left sided
Focal, trans-
mural, right sided
Mucosal atrophy Marked Minimal
Cytoplasmic mucin ↓ Preserved
Lymphoid aggregate Rare Common
Edema Minimal marked
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Features UC CDMorphologic
Hyperemia Extreme Minimal
Granuloma Absent 60% present
Fissuring Absent Present
Crypt abscess Common Rare
Lymph nodes Reactive Granulomas
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Indeterminate Colitis• Histopathologic and clinical overlap between
ulcerative colitis and Crohn disease is common, and it is not possible to make a distinction in up to 10% of patients with IBD. In such cases, termed indeterminate colitis, the small bowel is not involved, and the continuous pattern of colonic disease typically would indicate ulcerative colitis.
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