1. Ulcerative enterocolitis
Prepared by
Junaid Hamid

2. Definition
It is a chronic, reapsing and remitting, non
specific inflammatory disease of the colon,
characterized by suppurative ulceration of
the colon.

3. Epidemiology
• 5 to 10 per 100000 in a year
• Age 10 to 40 years
• More common in females
• Less common in smokers than in non
smokers

4. Pathology
• Retrosigmoid region in 50 % cases
• Left sided involving rectum, sigmoid
and descending colon in 30 %
• May involve the whole colon called as
total colitis in 20% cases

5. • The mucosa is red inflammed and bleeds
easily. With severe disease there is
xtensive ulceration with inflammatory
polyps.
• Microscopically the mucosa has
inflammatory cell infiltrate with goblet cell
depletion

6. Clinical features…
• Emotional stress, intercurrent infection,
gastroenteritis, antibiotics and NSAIDs are
all the precipitating factors.
• First attack is severe and then exacerbations
and remissions occur.
• In mild form there is gradual onset of
infrequent diarrhea with rectal bleeding.
There is also left lower quadrant cramps
relieved by defecation.

7. Clinical features…contd.
• In moderate case there is more severe
diarrhea with frequent. Abdominal pain
and tenderness is also present. Mild
fever anemia and hypoalbuminemia.
• In severe disease 6 to 10 bloody
diarrhea per day. Severe anemia,
hypovolemia, abdominal pain and
tenderness.

8. In chronic colitis the bowel is permanently
damaged by fibrosis and there is loss of the
absorbing property of the bowel.
There is a persistent diarrhea.

9. Investigations
• blood count od RBCs and leukocytes.
• ESR elevated
• Stool culture
• Sigmoidoscopy
• Plain x ray of the abdomen
• colonoscopy

10. Differential diagnosis
• Infectious colitis
• Amoebic colitis
• Pseudomembranous colitis
• Crohn’s disease
• Intestinal neoplasm
• Diverticulus
• Ischemic colitis

11. Complications
• Ischiorectal abscess
• Formation of fistula (rectovaginal)
• Constriction of rectum or colon
• Toxic dilation in severe acute attack
• Carcinoma of colon

12. Treatment
• Avoid caffeine and gas producin vegs.
• Fibers decrease diarrhea.
• Antidiarrheals should be avoided in
acute attack.

13. Treatment….contd
• Mesalazine enema 4 grams at bed time
• Hydrocortisone enema 80 to 100 mg
• Sulfasalazine 500 mg twice daily and
inreased gradually to 2 grams daily.
• Steroids are used if the patient is not
improving.

14. Treatment….contd
• If no improvement still then avoid oral
intake and use total parenteral nutrition.
• Restore circulatory volume with fluids
and blood as needed.

15. Treatment….contd
• Corticosteroid therapy
methylprednisolone
• Immunosuppressive therapy iv
cyclosporine or azathioprine in remission
• Surgical treatment in patients who do not
respond to corticosteroids and other
therapy. Removal of colon and rectum
(proctocolectomy) with connecting ileum
to the body surface (ileostomy)

16. THANX