ULCERATIVE COLITIS

2. Epidemiology
Highest 
incidence in
Europe, United
Kingdom, North
America
Incidence per
person-years
2.2–14.3/100,000
Age of onset 15–30 & 60–80
Male:female ratio 1:1
Smoking May prevent
disease
Oral contraceptives No increased risk
Appendectomy Protective
Monozygotic twins 6% concordance
Dizygotic twins 0% concordance

3. Etiology and Pathogenesis
:Consensus hypothesis 
genetically predisposed individuals
+
exogenous factors
+
host factors
↓
dysregulated mucosal immune function
(modified by specific environmental factors)

4. Pathology
:Macroscopic features 
mild inflammation -
moderate disease -
long-standing -
disease
fulminant disease -

5. Microscopic features 
process limited to the mucosa and superficial -
submucosa, with deeper layers unaffected
!((except in fulminant disease

6. Clinical presentation
:Signs and symptoms 
diarrhea -
rectal bleeding -
tenesmus -
passage of mucus -
abdominal pain -
other symptoms: -
anorexia, nausea,
vomiting, fever, weight
loss

7. Laboratory 
rise in acute-phase reactants -
erythrocyte sedimentation rate -
decrease in hemoglobin -
leukocytosis -
pANCAs -
(!Endoscopy (not in acute phase 
sigmoidoscopy -
colonoscopy -
Radiology 
barium enema -

8. Diagnosis relies on the patient's history,
clinical symptoms, negative stool examination
for bacteria, C. difficile toxin, and ova and
parasites; sigmoidoscopic appearance and
histology of rectal or colonic biopsy
!specimens

9. :Extraintestinal manifestations 
dermatologic - erythema nodosum, pyoderma -
gangrenosum
rheumatologic - peripheral arthritis, ankylosing -
spondylitis
ocular - conjunctivitis, uveitis/iritis, episcleritis -
hepatobiliary - steatosis, PSC -
urologic - calculi, ureteral obstruction, fistulas -
metabolic bone disorders - low bone mass -

10. Treatment

11. :Nutritional therapies 
total parenteral nutrition -
Surgical therapy 
indications: intractable disease, fulminant -
disease, toxic megacolon, colonic
perforation, massive colonic hemorrhage,
colonic obstruction, colon cancer prophylaxis,
colon dysplasia or cancer

12. :References
,Harrison’s Principles of Internal Medicine 
th edition 17