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Ulcerative colitis, classification, causes,clinical features, morphology, differential diagnosis with Crhon's disease
This document provides information about ulcerative colitis (UC) by discussing its epidemiology, morphology, clinical features, complications, diagnosis, comparisons to Crohn's disease, and indeterminate colitis. Key points include that UC is limited to the colon mucosa/submucosa, begins in the rectum and extends proximally, and causes bloody diarrhea, abdominal pain, and weight loss. It has a higher risk of colon cancer than Crohn's disease. Histopathology shows crypt abscesses and a continuous area of colon inflammation. Around 10% of IBD cases are considered indeterminate colitis with overlapping UC and Crohn's features.
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Ulcerative colitis, classification, causes,clinical features, morphology, differential diagnosis with Crhon's disease
- 1. IBD Ulcerative Colitis Ulcerative Proctosigmoiditis Lecture 13 ByDr Mohammad Manzoor
- 2. Ulcerative Colitis • UlcerativeColitis is an ulceroinflammatory disease affecting the colon, which is limited to the mucosa and submucosa, except in the most severe cases.
- 3. UC • It beginsin the rectum and extends proximally in a continuous fashion sometimes involving the entire colon (Pancolitis).
- 6. Epidemiology • More commonin 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 severeactive 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.
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- 13. Clinical features • Bloodymucoid 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, Ankylosingspondilitis, Uveitis, Erythema nodosum and Hepatic involvement (pericholangitis and Primary sclerosing (cholangitis).
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- 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 variousfactors in Crohn's disease and ulcerative colitis Crohn's Disease Involves terminal ileum Involves colon? Involves rectum? Ulcerative Colitis Commonly Seldom Usually Seldom Sometimes Always Usually Bile duct involvement? Not associated Higher rate of Primary sclerosing cholangitis Distribution of Disease Patchy areas of inflammation Continuous area of inflammation Endoscopy Linear and serpiginous (snake-like) ulcers Continuous ulcer Depth of inflammation May be transmural, deep into tissues Shallow, mucosal
- 18. Comparisons of variousfactors in Crohn's disease and UC (Cont.) Fistulae, abnormal Commonly Seldom Biopsy Can have granulomata Crypt abscesses and cryptitis Surgical cure ? Often returns Usually cured by removal of colon, passageways between organs following removal of affected part Smoking Higher risk for smokers Lower risk for smokers Autoimmune disease Generally regarded as an autoimmune disease No consensus Cancer risk? Lower than ulcerative colitis Higher than Crohn's Lymphoma Carcinoma
- 19. Features UC CD Morphologic Distribution Diffuse,mucosal Focal, trans&submucosal,mural, right left sided sided Mucosal atrophy Marked Minimal Cytoplasmic mucin ↓ Preserved Lymphoid aggregate Rare Common Edema marked Minimal
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- 21. Indeterminate Colitis • Histopathologicand 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.