1. ULCERATIVE COLITIS
SUBMITTED BY -
ARPIT JAIN
BAMS 2ND YEAR
BATCH - 2017-18

2. INTRODUCTION
 Ulcerative colitis is a fairly common long term condition that causes inflammation
in the colon. It is a form of inflammatory bowel disease (IBD) that is similar to
Crohn's disease.
 The colon removes nutrients from undigested food and eliminates the waste
products through the rectum and anus in the form of feces.
 In severe cases, ulcers form on the lining of the colon. These ulcers may bleed,
which produces pus and mucus.
 According to the Genetics Home Reference library, an estimated 750,000
people in the United States have ulcerative colitis. This is equivalent to 40–240 in
every 100,000 people.

3. SYMPTOMS
 Symptoms
 Share on PinterestAbdominal pain is a common symptom of ulcerative colitis.
 The first symptom of ulcerative colitis is usually diarrhea.
 Feces becomes progressively looser, and there may be abdominal pain with cramps and a
severe urge to pass stools.
 Diarrhea may begin slowly or suddenly. Symptoms depend on the extent and spread
of inflammation.
 The most common symptoms of ulcerative colitis include:
 abdominal pain
 bloody diarrhea with mucus

4.  The following might also occur:
 fatigue or tiredness
 weight loss
 loss of appetite
 anemia
 elevated temperature
 dehydration
 a constant urge to pass feces
 Symptoms are often worse early in the morning.
 Symptoms may be mild or absent for months or years at a time. However, they will
usually return without treatment and vary depending on the affected part of the colon.

5. TYPES
 Ulcerative proctitis
 This type affects only the end of the colon, or the rectum.
Symptoms tend to include:
 rectal bleeding, which may be the only symptom
 rectal pain
 an inability to move the bowels, despite frequent urges
 Ulcerative proctitis is usually the mildest type of ulcerative
colitis.

6. Colon affected by
ulcerative colitis With
massive
pseudopolyps(Inflamm
atory tissues).

7.  Proctosigmoiditis
 This involves the rectum and the sigmoid colon, which is
the lower end of the colon.
 Symptoms include:
 bloody diarrhea
 abdominal cramps
 abdominal pain
 a constant urge to pass stool

8. Left sided colitis
 This affects the rectum and the left side of
the sigmoid and descending colon.
 Symptoms usually include:
 bloody diarrhea
 abdominal cramping on left side
 weight loss

9.  Pancolitis
 This affects the whole colon. Symptoms include:
 occasionally severe, bloody diarrhea
 abdominal pain and cramps
 fatigue
 considerable weight loss

10.  Fulminant colitis
 This is a rare, potentially life threatening form of colitis
that affects the whole colon.
 Symptoms tend to include severe pain and diarrhea,
which can lead to dehydration and shock.
 Fulminant colitis can present a risk of colon rupture
and toxic megacolon, which causes the colon to
become severely distended

11. DIET
 Some dietary measures may help relieve symptoms, including:
 eating smaller, more regular meals, such as five or six small
meals per day
 drinking plenty of fluids, especially water, to prevent dehydration
 avoiding caffeine and alcohol, which can both increase diarrhea
 avoiding sodas, which can increase gas
 keeping a food diary to identify which foods make symptoms
worse

12. FOODS
THAT
HEAL
ULCERS

13.  A doctor may suggest temporarily following a specific diet depending on
symptoms, such as:
 a low fiber diet
 a lactose free diet
 a low fat diet
 a low salt diet
 It may help to take supplements or eliminate particular foods from the diet.
However, a person should discuss any complementary or alternative
measures with a doctor before trying them.

14.  Causes
 The exact causes of ulcerative colitis are unclear. However, they may involve the following:
 Genetics
 About one-fifth of people with ulcerative colitis have a close relative who has the same condition,
suggesting that it is heritable.
 Environmental
 The following environmental factors might affect the onset of ulcerative colitis:
 diet
 air pollution
 cigarette smoke
 poor hygiene

15.  Immune system
 The body might respond to a viral or bacterial infection in a way
that causes the inflammation associated with ulcerative colitis.
 Once the infection resolves, the immune system continues to
respond, which leads to ongoing inflammation.
 Another theory suggests that ulcerative colitis may be an
autoimmune condition. A fault in the immune system may cause
it to fight nonexistent infections, leading to inflammation in the
colon.

16. RISK FACTORS
Some known risk factors for ulcerative colitis include:
•Age: Ulcerative colitis can affect people at any age but is
more common at 15–30 years of age.
•Ethnicity: White people have a higher risk of developing
the condition, as do those of Ashkenazi Jewish descent.
•Genetics: Although recent studies have identified certain
genes that may play a role in ulcerative colitis, the link is
unclear due to the role of environmental factors.

17. DIAGNOSIS
 A doctor will ask about a person's symptoms and medical
history. They will also ask whether any close relatives
have had ulcerative colitis, IBD, or Crohn's disease.
 They will also check for signs of anemia, or low levels of
iron in the blood, and tenderness around the abdomen.
 Several tests can help rule out other possible conditions
and diseases, including Crohn's disease, infection,
and irritable bowel syndrome.

18. Crohn’s disease
and ulcerative
colitis

19.  These include:
 blood tests
 stool tests
 X-ray
 barium enema, during which a healthcare professional passes a fluid
called barium through the colon to show any changes or anomalies in a
scan
 sigmoidoscopy, in which a healthcare professional inserts a flexible tube
with a camera at the end, called an endoscope, into the rectum
 colonoscopy, wherein a doctor examines the whole colon using an
endoscope

20. TREATMENT
 A person with ulcerative colitis will need to see a doctor who
specializes in treating conditions of the digestive system, or a
gastroenterologist.
 They will assess the type and severity of the condition and create a
treatment plan.
 People with severe symptoms may require hospitalization, but a
person with mild-to-moderate symptoms will most likely need
outpatient treatment.
 Treatment will focus on:
 managing active symptoms until they go into remission
 maintaining remission to prevent further symptoms

21.  Managing active ulcerative colitis
 Treatment will involve the use of several types of medication. We
discuss these in the following sections:
 5-aminosalicylic acid
 This is the standard treatment option for ulcerative colitis.
Aminosalicylates tend to be effective in reducing inflammation.
 They often come in pill form, but doctors sometimes prescribe them
as suppositories. For those who have an allergy to sulfa, there are
also sulfa free forms available.

22.  The main forms include:
 mesalamine
 balsalazide
 sulfasalazine
 Side effects might include:
 nausea
 skin rash
 headaches
 diarrhea

24.  If the symptoms become severe or do not respond to aminosalicylates, a
doctor may prescribe steroids. These can also reduce inflammation.
 Prolonged use of steroids, especially oral steroids, can have serious side
effects. A doctor will usually recommend discontinuing steroid treatment
as soon as the condition responds.
 Side effects include:
 acne and other skin problems
 low mood
 sleep problems
 swelling
 indigestion

25.  Long term adverse effects include a higher risk of:
 bruising
 cataracts
 diabetes
 glaucoma
 high blood pressure
 muscle weakness
 osteoporosis
 thinning skin
 weight gain
 Immunosuppressants

26.  If other treatments have not been effective, or when the gastroenterologist needs to
discontinue steroids, immunosuppressants may help relieve symptoms. These
reduce immune activity and soothe inflammation in the colon and rectum.
 People tend to use an immunosuppressant called azathioprine to treat ulcerative
colitis.
 Possible side effects include:
 nausea
 diarrhea
 liver damage
 anemia
 bruising
 infections

28. BIOLOGICS
 Biologics
 Doctors may prescribe antitumor necrosis factor agents to
bring about remission.
 These include:
 infliximab (Remicade)
 adalimumab (Humira)
 golimumab (Simponi)
 Vedolizumab (Entyvio), a different biologic that targets the
gut mucosal immune system

29. SURGERY
 Surgery
 If other treatments do not provide relief, surgery may be an option.
 Some surgical options include:
 Colectomy: A surgeon removes part or all of the colon.
 Ileostomy: A surgeon makes an incision in the stomach, extracts the
end of the small intestine, and connects it to an external pouch, called
a Kock pouch. The pouch then collects waste material from the
intestine.
 Ileoanal pouch: A surgeon constructs a pouch from the small
intestine and connects it to the muscles surrounding the anus. The
ileoanal pouch is not an external pouch.

30. COMPLICATIONS
 Complications
 The possible complications of ulcerative colitis range from a lack of
nutrients to potentially fatal bleeding from the rectum. We cover more
possible complications in the sections below:
 Colorectal cancer
 Ulcerative colitis, especially if symptoms are severe or extensive,
increases the risk of developing colon cancer.
 According to the National Institute of Diabetes and Digestive and
Kidney Diseases, colon cancer risk is highest when ulcerative colitis
affects the entire colon for longer than 8 years.
 Males with ulcerative colitis also have a higher risk of colon cancer
than females with the condition.

31.  Other possible complications of ulcerative colitis include:
 inflammation of the skin, joints, and eyes
 liver disease
 osteoporosis
 perforated colon
 severe bleeding
 severe dehydration
 To prevent a loss of bone density, a doctor may prescribe vitamin
D supplements, calcium, or other medications.

32. REFERENCES
PATHOLOGY By Harshmohan
ANATOMY By BD Chaurasia
INTERNET

33. THANK YOU