Definition Ulcerative Colitis is recurring episodes of inflammation of the mucosal layer of the colon.

Generally it begins at the rectum and proceeds proximally in a continuous fashion through the colon.

from UC. UC is also associated with HLA-B27 and pANCA (Higher levels tend to correlate with earlier surgeries). Histology shows evidence of crypt distortion (unique to UC). Treatment First line treatment includes corticosteroids and other anti-inflammatories. Surgery is indicated for more severe cases. In all patients more frequent colonoscopy is indicated. For mild disease, topical Asacol to the rectum in conjunction with aminosalycilates or oral steroids is standard. For more severe cases, stronger anti-inflammatory medications or partial resection of the colon are indicated. Complications Fistulae, abscess, sexual dysfunction, pouchitis (malaise and/or fever, incontinence, frequent stools), toxic megacolon, and carcinoma are all known complications.

Fig. 2. Ulcerative Colitis. Note the inflamed mucosa and patchy nature of the lesion.1 Signs and Symptoms Presentation: Gradual onset, starting mildly (generally). Mild: Confined to rectum and sigmoid colon. Prodrome of faint crampy pain, constipation, tenesmus, mucuslike stools. No bleeding, fever, or weight loss.

Moderate: Expanded inflammation past splenic flexure. Prodrome of frequent loose, bloody stools (<10/day), mild anemia, low grade fever, and abdominal pain. Severe: Exhibits extension as far as cecum, >10 bloody stools per day, fever over 103.3F, anemia to the point of blood transfusion, and sever weight loss and malnutrition. Differential Diagnosis Crohns Disease: Patchy, porridge-like or fatty stools, common fever, fistulae, weight loss, transmural inflammation, and granulomas on histology. Smoking is associated with higher risk (Smoking is risk lowering for UC). Rarely involves rectum, but does involve anus (UC is opposite). Radiation Colitis: More bloody, radiation exposure. Ischemic Colitis: Differentiate on colonoscopy and with angiogram and/or Doppler/CT. Infection: Blood and stool cultures to rule out infection. Medication: NSAIDs, Retinoic Acid, Gold, Oral Contraceptives, Penicillin. Workup Full H&P followed by CBC, Complete Metabolic panel, and obtaining cultures, flexible sigmoidoscopy should be performed to diagnose and stage. Double constrast barium radiograph can aid in differentiating Crohns

Fig. 2. Contrast radiograph of burnt out UC.1 Prognosis Most patients experience intermittent exacerbation and remission. With proper care, Ulcerative Colitis is a chronic, yet manageable disease. Sources 1. http://www.uptodate.com/contents/clinicalmanifestations-diagnosis-and-prognosis-of-ulcerativecolitis-inadults?source=search_result&search=Ulcerative+Colitis &selectedTitle=2~150 2. http://emedicine.medscape.com/article/183084overview