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IBD Ulcerative Colitis Lecture 13 By Dr Mohammad Manzoor Ulcerative Proctosigmoiditis

Ulcerative colitis, classification, causes,clinical features, morphology, differential diagnosis with Crhon's disease

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Page 1: Ulcerative colitis, classification, causes,clinical features, morphology, differential diagnosis with Crhon's disease

IBD

Ulcerative Colitis

Lecture 13 By Dr Mohammad Manzoor

Ulcerative Proctosigmoiditis

Page 2: Ulcerative colitis, classification, causes,clinical features, morphology, differential diagnosis with Crhon's disease

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.

Page 3: Ulcerative colitis, classification, causes,clinical features, morphology, differential diagnosis with Crhon's disease

UC• It begins in the rectum and extends

proximally in a continuous fashion sometimes involving the entire colon (Pancolitis).

Page 4: Ulcerative colitis, classification, causes,clinical features, morphology, differential diagnosis with Crhon's disease
Page 5: Ulcerative colitis, classification, causes,clinical features, morphology, differential diagnosis with Crhon's disease
Page 6: Ulcerative colitis, classification, causes,clinical features, morphology, differential diagnosis with Crhon's disease

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.

Page 7: Ulcerative colitis, classification, causes,clinical features, morphology, differential diagnosis with Crhon's disease

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.

Page 8: Ulcerative colitis, classification, causes,clinical features, morphology, differential diagnosis with Crhon's disease
Page 9: Ulcerative colitis, classification, causes,clinical features, morphology, differential diagnosis with Crhon's disease

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).

Page 10: Ulcerative colitis, classification, causes,clinical features, morphology, differential diagnosis with Crhon's disease
Page 11: Ulcerative colitis, classification, causes,clinical features, morphology, differential diagnosis with Crhon's disease

Morphology• A diffuse, predominantly mononuclear

inflammatory infiltrate in the lamina propria and Crypt abscesses.

Page 12: Ulcerative colitis, classification, causes,clinical features, morphology, differential diagnosis with Crhon's disease

Complications:• Perforation,

• peritonitis,

• abscess

• Toxic megacolon

• Venous thrombosis

• Carcinoma

Page 13: Ulcerative colitis, classification, causes,clinical features, morphology, differential diagnosis with Crhon's disease

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

Page 14: Ulcerative colitis, classification, causes,clinical features, morphology, differential diagnosis with Crhon's disease

Extra-intestinal symptoms

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

Page 15: Ulcerative colitis, classification, causes,clinical features, morphology, differential diagnosis with Crhon's disease

Diagnosis•Endoscopy•Biopsy

Page 16: Ulcerative colitis, classification, causes,clinical features, morphology, differential diagnosis with Crhon's disease

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.

Page 17: Ulcerative colitis, classification, causes,clinical features, morphology, differential diagnosis with Crhon's disease

Comparisons of various factors in Crohn's disease and ulcerative colitis

Crohn's Disease Crohn's Disease Ulcerative Colitis Ulcerative Colitis

Involves terminal ileum Involves terminal ileum Commonly Commonly Seldom Seldom

Involves colon? Involves colon?

Involves rectum? Involves rectum?

Usually Usually

Seldom Seldom

Always Always

Usually Usually

Bile duct involvement? Bile duct involvement? Not associated Not associated Higher rate of Primary Higher rate of Primary sclerosing cholangitis sclerosing cholangitis

Distribution of Disease Distribution of Disease Patchy areas of Patchy areas of inflammation inflammation

Continuous area of Continuous area of inflammation inflammation

Endoscopy Endoscopy Linear and serpiginous Linear and serpiginous (snake-like) ulcers (snake-like) ulcers

Continuous ulcer Continuous ulcer

Depth of inflammation Depth of inflammation May be transmural, deep May be transmural, deep into tissues into tissues

Shallow, mucosal Shallow, mucosal

Sometimes

Page 18: Ulcerative colitis, classification, causes,clinical features, morphology, differential diagnosis with Crhon's disease

FistulaeFistulae, , abnormal abnormal passageways between passageways between

organs organs

Commonly Commonly Seldom Seldom

Biopsy Biopsy Can have Can have granulomagranulomata ta Crypt abscesses and Crypt abscesses and cryptitis cryptitis

Surgical cure ?Surgical cure ?

Smoking Smoking

Often returnsOften returns following removal of following removal of

affected part affected part

Higher risk for smokers Higher risk for smokers

Usually cured by Usually cured by removal of colon, removal of colon,

Lower risk for smokers Lower risk for smokers

Autoimmune disease Autoimmune disease Generally regarded as Generally regarded as an autoimmune an autoimmune

disease disease

No consensus No consensus

Cancer risk? Cancer risk? Lower than ulcerative Lower than ulcerative colitis colitis

Higher Higher than Crohn's than Crohn's

Comparisons of various factors in Crohn's disease and UC (Cont.)

Lymphoma Carcinoma

Page 19: Ulcerative colitis, classification, causes,clinical features, morphology, differential diagnosis with Crhon's disease

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

Page 20: Ulcerative colitis, classification, causes,clinical features, morphology, differential diagnosis with Crhon's disease

Features UC CDMorphologic

Hyperemia Extreme Minimal

Granuloma Absent 60% present

Fissuring Absent Present

Crypt abscess Common Rare

Lymph nodes Reactive Granulomas

Page 21: Ulcerative colitis, classification, causes,clinical features, morphology, differential diagnosis with Crhon's disease

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.

Page 22: Ulcerative colitis, classification, causes,clinical features, morphology, differential diagnosis with Crhon's disease