Ulcerative colitis is an inflammatory bowel disease that affects the colon in a continuous pattern from the rectum upwards. It involves only the mucosa and submucosa. Key features include bloody diarrhea, abdominal pain, and weight loss. Diagnosis is made through endoscopy, biopsy, and ruling out Crohn's disease which can have a patchy transmural involvement pattern and granulomas on biopsy. The risk of colon cancer is higher with ulcerative colitis compared to Crohn's disease. Indeterminate colitis is diagnosed when the features overlap between the two conditions and it is not possible to distinguish.

1. IBD
Ulcerative
ColitisUlcerative Proctosigmoiditis

2. Ulcerative Colitis
• Ulcerative Colitis is an ulceroinflammatory
disease affecting the colon, which is limited to
the mucosa and submucosa, except
in the most severe cases.

3. UC
• It begins in the rectum and extends
proximally in a continuous fashion
sometimes involving the entire colon
(Pancolitis).

6. Epidemiology
• More common in USA & Western countries.
The incidence has risen in recent decades.
More common among whites. Females are
affected slightly more. A peak incidence
between ages 20-25 years. Has a familial
association.

7. Morphology
• Gross:
• Rectum & Sigmoid --may involve entire colon.
• The lesions are continuous.
• inflammatory destruction of the mucosa with
macroscopic appearance of :
• Hyperemia, edema, and granularity with
friability and easy bleeding.

9. Morphology
• With severe active disease:
• Extensive and broad based ulceration in the distal
colon.
• Pseudopolyps
• Toxic megacolon
Pseudopolyps are projecting masses of scar tissue
that develop from granulation tissue during the
healing phase in repeated cycle of ulceration
(especially in inflammatory bowel disease).

11. Morphology
• A diffuse, predominantly mononuclear
inflammatory infiltrate in the lamina propria
and Crypt abscesses.

12. Complications:
• Perforation,
• peritonitis,
• abscess
• Toxic megacolon
• Venous thrombosis
• Carcinoma

13. Clinical features
• Bloody mucoid diarrhea
• Cramps ( a painful & involuntary muscular contraction)
• Tenesmus (painful spasm of the anal sphincter along with the urgent desire to defecate
without the significant production of feces)
• Colicky lower abdominal pain
• Fever
• Weight loss

14. Extra-intestinal symptoms
• Migratory polyarthritis,
• Sacroilitis,
• Ankylosing spondilitis,
• Uveitis,
• Erythema nodosum and
• Hepatic involvement (pericholangitis and
• Primary sclerosing (cholangitis).

15. Diagnosis
•Endoscopy
•Biopsy

16. Comparison of CD &UC
• Crohn disease and ulcerative colitis differ in
many respects, including the natural history of
the disease, pathological aspects, and in the
types of therapies and responses to
treatment.

17. Comparisons of various factors in Crohn's disease and ulcerative colitis
Crohn's DiseaseCrohn's Disease Ulcerative ColitisUlcerative Colitis
Involves terminal ileumInvolves terminal ileum CommonlyCommonly SeldomSeldom
Involves colon?Involves colon?
Involves rectum?Involves rectum?
UsuallyUsually
SeldomSeldom
AlwaysAlways
UsuallyUsually
Bile duct involvement?Bile duct involvement? Not associatedNot associated Higher rate of PrimaryHigher rate of Primary
sclerosing cholangitissclerosing cholangitis
Distribution of DiseaseDistribution of Disease Patchy areas ofPatchy areas of
inflammationinflammation
Continuous area ofContinuous area of
inflammationinflammation
EndoscopyEndoscopy Linear and serpiginousLinear and serpiginous
(snake-like) ulcers(snake-like) ulcers
Continuous ulcerContinuous ulcer
Depth of inflammationDepth of inflammation May be transmural, deepMay be transmural, deep
into tissuesinto tissues
Shallow, mucosalShallow, mucosal
Sometimes

18. FistulaeFistulae,, abnormalabnormal
passageways betweenpassageways between
organsorgans
CommonlyCommonly SeldomSeldom
BiopsyBiopsy Can haveCan have granulomagranulomatata Crypt abscesses andCrypt abscesses and
cryptitiscryptitis
Surgical cure ?Surgical cure ?
SmokingSmoking
Often returnsOften returns
following removal offollowing removal of
affected partaffected part
Higher risk for smokersHigher risk for smokers
Usually cured byUsually cured by
removal of colon,removal of colon,
Lower risk for smokersLower risk for smokers
Autoimmune diseaseAutoimmune disease Generally regarded asGenerally regarded as
an autoimmunean autoimmune
diseasedisease
No consensusNo consensus
Cancer risk?Cancer risk? Lower than ulcerativeLower than ulcerative
colitiscolitis
HigherHigher than Crohn'sthan Crohn's
Comparisons of various factors in Crohn's disease and UC
(Cont.)
Lymphoma Carcinoma

19. Features UC CD
Morphologic
Distribution Diffuse,mucosal
&submucosal,
left sided
Focal, trans-
mural, right
sided
Mucosal atrophy Marked Minimal
Cytoplasmic mucin ↓ Preserved
Lymphoid aggregate Rare Common
Edema Minimal marked

20. Features UC CD
Morphologic
Hyperemia Extreme Minimal
Granuloma Absent 60% present
Fissuring Absent Present
Crypt abscess Common Rare
Lymph nodes Reactive Granulomas

21. Indeterminate Colitis
• Histopathologic and clinical overlap between
ulcerative colitis and Crohn disease is common, and
it is not possible to make a distinction in up to 10%
of patients with IBD. In such cases, termed
indeterminate colitis, the small bowel is not
involved, and the continuous pattern of colonic
disease typically would indicate ulcerative colitis.