Definition of Ulcerative colitis Ulcerative colitis (UC) is a non-specific inflammatory condition of the colon(Porth, 2007).

UC is one of the two main forms of chronic inflammatory disease of the gastrointestinal tract; called inflammatory bowel disease (IBD) .The disease may involve the rectum alone (ulcerative proctitis); the rectum and the sigmoid colon (proctosigmoiditis) or the entire colon (pancolitis) Etiology of Ulcerative colitis The etiology of ulcerative colitis is unknown. Many theories have been developed in an attempt to explain this health condition. Ulcerative colitis is believed to be multifactorial where proposed causes include environmental factors, immune dysfunction, and genetic predisposition

1. Environmental factors

Diet: Intake of unhealthy food and low-residue high-refined sugar have been considered to be contributory factors in the development of ulcerative colitis

Infections: Some researchers feel that ulcerative colitis may be related to certain digestive infections caused by the microorganism E. Coli. It is also believed that modern measles virus, improperly cleared from the body, results in low grade, chronic inflammation of the intestinal lining.

Drugs: Studies have linked the intake of oral contraceptive pill, antibiotics and other drugs to the development Ulcerative colitis. E.g. Isotretinoin, a commonly used drug for severe acne is found to trigger UC in some patients.

2. Immune dysfunction

Disturbances of the immune system: Some experts believe that there may be a defect in ones immune system responsible for ongoing inflammation in the intestinal wall.

Allergy: Some studies suggest that Ulcerative colitis is a form of exaggerated allergic response to certain food or to the presence of some microorganisms present in the intestine.

Autoimmune disease: Most recent research indicate that ulcerative colitis can be a form of autoimmune disease in which bodys defense system starts attacking bodys own organs and tissues.

3. Genetics Current research suggests that certain genetic factors may increase the likelihood of person having Ulcerative colitis. If someones immediate family members has ulcerative colitis, then ones chances of having the disease increases.

Pathophysiology

Macroscopically, most cases of UC arise in the rectum, with some patients developing terminal ileitis. The bowel wall is thin or of normal thickness, but the presence of edema, the accumulation of fat, and hypertrophy of the muscle layer may give the impression of a thickened bowel wall. Microscopically, UC involves only the mucosa, with the formation of crypt abscesses and a coexisting depletion of goblet cell mucin. In severe cases, the submucosa can be involved, and in some cases, the deeper muscular layers of the colonic wall can also be affected. Further microscopic changes include inflammation of the crypts of Lieberkuhn and abscesses. Ulcerated areas are soon covered by granulation tissue. The undermined mucosa and; the excess granulation tissue form polypoidal mucosal excrescences. These are known as inflammatory polyps or pseudopolyps.

Signs and symptoms

The clinical presentation of ulcerative colitis depends on the extent of the disease process. They may come on suddenly or develop gradually.

The three classic symptoms of ulcerative colitis are:

Persistent or recurrent diarrhea (in ulcerative colitis this diarrhea is often bloody or full of mucus)

Abdominal pain (which in ulcerative colitis is often crampy in nature and most intense immediately before a bowel movement)

Fever (Ulcerative colitis is an inflammatory disease, and one of the key characteristics of the inflammatory process is fever (the others being pain, heat, and redness). Some

individuals with ulcerative colitis suffer a high fever, especially during the acute phase of a flare-up. Others run a persistent, low-grade fever)

Other symptoms may include: peri-anal irritation, fissures, hemorrhoids, fistulas, abscesses, fatigue, weight loss and loss of appetite

Additionally, since ulcerative colitis is associated with the general inflammatory process some symptoms of this disorder are manifested in other systems of the body

Among these are:

Reddening and inflammation of the eye (iritis) Joint pains, usually in the large joints of the knees, ankles, elbows, wrists, and shoulders, which sometimes migrate from one joint to another (migrating arthralgia)

Skin lesions including tender red nodules on the shins or calves (erythma nodosum) Sores inside the mouth (aphthous ulcers)

Diagnosis

The initial diagnostic workup for ulcerative colitis includes the following:

A complete blood count is done to check for anemia Electrolyte studies and renal function tests are done, as chronic diarrhea may be associated with hypokalemia, hypomagnesmia and pre-renal failure.

Liver function tests are performed to screen for bile duct involvement. X- ray Urinalysis Stool culture, to rule out parasites and infectious causes.

Erythrocyte sedimentation rate can be measured, with an elevated sedimentation rate indicating that an inflammatory process is present.

C- reactive protein can be measured, with an elevated level being another indication of inflammation.

Treatment

Medical management of ulcerative colitis begins with an attempt to reduce the symptoms and bring on a remission. After this is accomplished, the goal is to maintain remission for as long as possible.

Treatment options include:

Medication Surgery Alternative treatments

Medications

Most of the medications used to treat ulcerative colitis are generally safe for long-term use, and many individuals stay on maintenance doses of medications indefinitely. Medications include:

5-ASA compounds (aminosalicylic acid) Steroids Medications to suppress the immune system

Surgery

Colectomy is the only one surgical treatment for ulcerative colitis, Surgery for ulcerative colitis involves removal of the entire colon, regardless of whether all or only a portion of the colon is diseased. This surgical procedure cures the disease, since the diseased organ is removed. But this surgery is life altering, since other methods must be used after the surgery for eliminating waste from the body.

Alternative Treatments

Mind-body treatments can help individuals with ulcerative colitis manage pain, can contribute to a sense of well-being, and can give individuals a sense of control over a situation where, in medical terms, they have little or no control.

Mind-body treatments include:

Biofeedback Hypnotherapy Sound/music therapy Relaxation techniques

Porth, C. (2007). Essentials of pathophysiology, concepts of altered health states. (2nd ed.). Philadelphia,PA: Lippincott Williams & Wilkins. Slowik, G. S. (2010, December 27). What are the symptoms of ulcerative colitis?. Retrieved from http://ehealthmd.com/content/what-are-symptoms-ulcerative-colitis