Ulcerative Colitis
Not yet clinically reviewed
This protocol was migrated from the earlier Pharmapedia and Ward Guide apps for educational use. Follow your hospital's own policies and consult seniors when in doubt.
- UC is confined to the colon and rectum and affects primarily the mucosa and the submucosa. The primary lesion occurs in the crypts of the mucosa (crypts of Lieberkühn) in the form of a crypt abscess.
- Local complications (involving the colon) occur in the majority of patients with UC. Relatively minor complications include hemorrhoids, anal fissures, and perirectal abscesses.
- A major complication is toxic megacolon, a severe condition that occurs in up to 7.9% of UC patients admitted to hospitals. The patient with toxic megacolon usually has a high fever, tachycardia, distended abdomen, elevated white blood cell count, and a dilated colon.
- The risk of colonic carcinoma is much greater in patients with UC as compared with the general population.
- Approximately 11% of patients with UC have hepatobiliary complications, including fatty liver, peri cholangitis, chronic active hepatitis, cirrhosis, sclerosing cholangitis, cholangiocarcinoma, and gallstones.
- Arthritis commonly occurs in patients with IBD and is typically asymptomatic and migratory. Arthritis typically involves one or a few large joints, such as the knees, hips, ankles, wrists, and elbows.
- Ocular complications (iritis, episcleritis, and conjunctivitis) occur in 2% to 29% of patients. Skin and mucosal lesions associated with IBD include erythema nodosum, pyoderma gangrenosum, aphthous ulceration, and sweet syndrome.
Clinical Presentation of Ulcerative Colitis
Signs and symptoms: Abdominal cramping, Frequent bowel movements, often with blood in the stool, Weight loss, Fever and tachycardia in severe disease, Blurred vision, eye pain, and photophobia with ocular involvement, Arthritis, Raised, tender red nodules that vary in size from 1 cm to several centimeters.
Physical examination: Hemorrhoids, fissures, or perirectal abscesses may be present. Iritis, uveitis, episcleritis, and conjunctivitis with ocular involvement, Dermatologic findings with erythema nodosum, pyoderma gangrenosum, or aphthous ulceration
Laboratory tests: Decreased hematocrit/hemoglobin, Increased erythrocyte sedimentation rate, Leukocytosis and hypoalbuminemia with severe disease, (+) perinuclear antineutrophil cytoplasmic antibodies