Ulcerative colitis is a chronic inflammatory bowel disease that affects the colon. It causes abdominal pain, diarrhea, and can lead to serious complications like toxic megacolon. The cause is unknown but may involve genetics and the immune system. Diagnosis involves clinical evaluation, endoscopy, and biopsy. Treatment focuses on reducing inflammation with medications like mesalamine or immune suppressors. Surgery may be needed if other treatments fail or complications arise.

1. Ulcerative colitis
Dr Muhammad Yunus Khan
Assistant Professor
Surgical A ward
Khyber Teaching Hospital

2. Definition
Ulcerative colitis is an inflammatory bowel
disease (IBD) that causes chronic inflammation of
the digestive tract

3. Symptoms
It is characterized by:
-abdominal pain
-diarrhea.
Like Crohn's disease, another common IBD,
ulcerative colitis can be debilitating and sometimes can
lead to life-threatening complications

4. Ulcerative colitis usually affects only the innermost
lining of the large intestine (colon) and rectum.
-It occurs only through continuous stretches of the
colon, unlike Crohn's disease, which occurs in
patches anywhere in the digestive tract and often
spreads deep into the layers of affected tissues

5. Etiology of UC
:Unknown, unclear
- Heredity
- autoimmune reaction
- Inflammatory reaction
- Stress ( precipitates symptoms rather than causes
UC )

6. Diagnosis of UC
- Clinical manifestation
• Abdominal pain
• Diarrhea (bloody diarrhea)
- Endoscopy
- Biopsy

8. Complications of UC
- Toxic megacolon
The most serious acute complication of ulcerative colitis that occurs
when the colon becomes paralyzed, resulting in no bowel
movement or passing gas

9. Signs and symptoms of toxic megacolon include
fever, abdominal pain and swelling, weakness and
disorientation
If toxic megacolon isn't treated, the colon may
rupture, causing peritonitis, a life-threatening
condition requiring emergency surgery.

10. Complications of UC
Other complications to UC include:
- Perforated colon
- Severe dehydration
- Liver disease
- Inflammation of the skin, joints and eyes
- Colon cancer

11. Treatment
There's no known cure for ulcerative colitis, but
therapies are available that may dramatically
reduce
the signs and symptoms of ulcerative colitis and
even
bring about a long-term remission
Ulcerative colitis treatment usually involves either
drug therapy or surgery
The goal of medical treatment is to reduce the
inflammation that triggers the signs and symptoms

12. Medical Treatment
A. Anti-inflammatory drugs
Anti-inflammatory drugs are often the first step in
the treatment of IBD. They include:
- Sulfasalazine
It is a sulfa drug, in the gut is converted to
sulfapyridine and 5-ASA ( 5-amino salicylates )
5-ASA remains in the colon and has good
antiinflammatory effect
-

13. - Mesalamine and olsalazine
These medications tend to have fewer side effects
than sulfasalazine has.
- Balsalazide
This drug is similar to sulfasalazine, but produces
fewer side effects

14. - Corticosteroids
Corticosteroids can help reduce inflammation,
but they have numerous side effects, including a
puffy face, excessive facial hair, night sweats,
insomnia and hyperactivity, high blood pressure,
type II diabetes, osteoporosis, bone fractures,
cataracts and an increased susceptibility to
infections.
Long-term use of steroid drugs is not advised

15. B. Immune system suppressors :
- Azathioprine and Mercaptopurine
- Cyclosporine
- Infliximab

16. Nicotine skin patches
These skin patches - the same kind smokers use - seem to provide
short-term relief from flare-ups of ulcerative colitis for some
people, especially people who formerly smoked

17. Other medications
In addition to controlling inflammation, some
medications may help relieve UC signs and
symptoms.
- Anti-diarrheals
- Pain relievers. For mild pain e.g headache use
acetaminophen . NSAIDs are contraindicated
because they lead to diarrhea
- Iron supplements. If patients have chronic
intestinal bleeding, they may develop iron
deficiency anemia

18. Surgery
If diet and lifestyle changes, drug therapy or other
treatments don't relieve signs and symptoms of
UC, surgery is recommend

20. Ischemic Colitis
• Ischemia of the colon most often affects the elderly (90% of
patients > 60 y/o ).
• Ischemic colitis is almost always nonocclusive. (emboli are the most
common cause of acute mesenteric ischemia)
• Shunting of blood away from the mucosa may contribute to this
condition, but the mechanism is unknown.

21. Ischemic Colitis
• Most patients ischemia occurs secondary to arteriolar shunting,
spasm, or poor perfusion of mucosal vessels.
• Most cases involve the splenic flexure, which is supplied by end-
arteries.
• The rectum is usually spared, because its blood supply is different
from the rest of the colon and less dependent on the inferior
mesenteric artery .

22. Types of Ischemic Colitis
1. Acute fulminant ischemic colitis
2. Subacute ischemic colitis

23. Acute fulminant ischemic colitis manifestations
1. The onset is characteristically acute, with generalized lower
abdominal pain, usually in the left lower quadrant, followed
within 24 hours by bloody diarrhea or rectal bleeding .
2. Dilation of the colon and physical signs of peritonitis are seen in
severe cases.
3. With the gangrenous type, both symptoms and signs progress
rapidly.

24. Acute fulminant ischemic colitis Diagnostic
Strategy
•Nospecific serum markers proven in the diagnosis of intestinal
ischemia.
• Abdominal films may reveal thumbprinting from submucosal
hemorrhage and edema .
* (barium enema is contraindicated in cases of gangrenous
ischemic colitis because of the risk of perforation )

25. Acute fulminant ischemic colitis Diagnostic
Strategy
• Sigmoidoscopy or colonoscopy may detect ulcerations, friability, and
bulging folds from submucosal hemorrhage. (Colonoscopy is
preferred over sigmoidoscopy )
• The segmental distribution and rectal sparing of the disease process
are suggestive but are not diagnostic.

26. Acute fulminant ischemic colitis Diagnostic
Strategy
•Angiography is not helpful in the
management of patients with presumed
ischemic colitis because a remediable
occlusive lesion is very rarely found.
• CT scan is normal in early stages of bowel infarction, although it may
show nonspecific findings such as bowel wall thickening and
pneumatosis.

27. Pneumatosis Intestinalis

29. Acute fulminant ischemic colitis
management
•Gangrenous ischemic colitis or
evidence of perforation requires
immediate surgery as soon as the
patient is stabilized.

31. management
•Vasopressors should be avoided, if
possible.
•Low blood-flow states (hypotension)
should be aggressively reversed.

32. Differential Diagnosis
Clinical Radiologic
Ulcerative
colitis
Bloody diarrhea Extends proximally from rectum; fine
mucosal ulceration
Crohn’s
colitis
Perianal lesions
common; frank
bleeding less
frequent than in
ulcerative colitis
Segmental disease; rectal sparing;
strictures, fissures, ulcers, fistulas;
small bowel involvement
Ischemic
colitis
Older age groups;
vascular disease;
sudden onset, often
painful
Splenic flexure; “thumb printing”;
rectal involvement rare