Lecture notes
ulcerative colitis
- Module
- General Surgery 2
- Institution
- Cambridge University (CAM)
Lecture notes of 9 pages for the course General Surgery 2 at CAM (.)
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Ulcerative Colitis•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.
•Ulcerative colitis is, however, a systemic disease that affects many parts of the body
outside the intestine
AETILOGY
Exact cause is unknown. Several causes have been suggested.
Genetic factors:
-Aggregation of ulcerative colitis in families.
-Identical twin concordance rate of 10% and dizygotic twin concordance rate of 3%
-Ethnic differences in incidence
Environmental Factors:
Diet: as the colon is exposed to many different dietary substances which may encourage
inflammation, dietary factors have been hypothesized to play a role in the pathogenesis
Breastfeeding: potential protective
Other childhood exposures or infections
Autoimmune disease:
Autoimmune disease in which immune system malfunctions, attacking some parts of
body. But it is seen that surgical removal of large intestine cures disease, including
manifestations outside digestive system. This suggests cause of disease is in colon itself,
not in immune system.
Alternative theories:
1
, Levels of sulfate-reducing bacteria tend to be higher in persons with ulcerative colitis.
This could mean that there are higher levels of hydrogen sulfide in the intestine -toxic
effects of the hydrogen sulfide on the cells lining the intestine.
Epidemiology
•Incidence: 3-15/100,000
•Peak incidence between 15 and 30 years
•Second peak between 50 to 80 years
•Higher incidence in Jewish populations
•affects females more than males
•Negative correlation between smoking and ulcerative colitis
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.
Classification
Extent of involvement
The disease is classified by the extent of involvement, depending on how far up the
colon the disease extends
1. Distalcolitis
A. Proctitis: Involvement limited to the rectum.
B. Proctosigmoiditis: Involvement of the rectosigmoidcolon.
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
2
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