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Ulcerative colitis affects the mucous linings of the colon. It starts in the rectum and by way of continuity spreads to the caecum. Clinically may be mild with rectal bleeding as the only manifestation, but may also be severe resulting in toxicity similar to fulminating dysentery. The course of the disease is characterized by relapses and remissions. The treatment is not specific.

Ulcerative colitis is a chronic non-specific diffuse inflammatory disease of the colon characterized by multiple ulcerations, and desquamation of the colonic epithelium.

*Aetiology*
The specific chase of ulcerative colitis is not known. No infective agent has been identified in a consistent manner to be regarded as the specific cause.

Similarly, allergy to food as a cause is not regarded as important except occasionally to milk.

Psychological factors tend to aggravate the disease rather than being a cause. However, there is a familial tendency; with a higher incidence in females than males.

Auto-immune mechanisms have been suggested because of studies that demonstrated abnormalities in humoral and cell-mediated immunity in patients with inflammatory bowel disease.

Also, Read More Details: Ulcerative colitis: Aetiology, Pathophysiology, Diagnose, Complications, treatment

*Pathophysiology*
The disease may be limited to the rectum, distal colon, or total colon. Proctitis, distal colitis and total colitis are used to describe the involvement of the rectum, distal colon, and total colon respectively.

The mucous lining is swollen and reddened in the early stages. Pointed areas of bleeding may be seen. Therefore ulceration develops. The ulcers may be superficial or penetrate deeply.

If ulceration becomes severe, the mucous lining may Slough in some parts to expose the underlining granular tissue. The remaining mucosa becomes oedematous, hyperplastic, and raised, resembling pesudo-polyps.

Individuals with only partial rectal involvement show manifestations such as the passage of blood and mucus rectally with constipated stool. However, in fulminant colitis where there is extensive and total colonic involvement, the patient looks ill, is febrile, has tachycardia, and passes frequent liquid foul-smelling stools mixed with blood and mucus. The bowel opening may be up to 20 times per day.

There the abdominal pain and abdominal distension. These manifestations are due to inflammatory changes resulting in ulceration, irritation of the colon and its inability to perform its functions of removal of water from intestinal contents

Anaemia may occur due to blood loss and depression of erythropoiesis and electrolyte depletion may occur. Weight loss is mainly caused by poor food intake as a result of anorexia or fear of aggravating diarrhea.

Local extension of the disease may result in complications such as anorectal fistulae and strictures of the colon. Perforation of the bowel may occur due to toxic dilation of the colon especially when the mucosal inflammation progresses to other layers of the colonic tissue. Cancer bowel involvement for 10 years.

Systemic complications include erythema, nodusum, psoriasis, episcleritis, and specific arthritis affecting large joints.

*Clinical manifestation*

1. Diarrhoea with loose bloody mucoid stools.
2. Lower abdominal pain.
3. Tenderness on palpation of the colon.
4. Increase in body temperature.
5. Dehydration.
6. Weight loss.

*Complications*
1. Anaemia
2. Anorectal fistulae
3. Strictures of the colon
4. Colonic perforation
5. Carcinoma of the colon
6. Erythema nodosum
7. Pyoderma gangrenosum
8. Psoriaris
9. Enteropathic arthritis
10. Aphthous stomatitis
11. Septicaemia

*Diagnostic evaluation*
1. Sigmoidoscopy
2. Rectal biopsy
3. Barium enema examination

*Management*
The aim of management in ulcerative colitis is to reduced inflammation, suppress the inappropriate immune response, and provide rest for the diseased colon. These measures promote healing and can be achieved with the use of drugs, dietary modification, and surgical intervention.

*Dietary*
Well-balanced, low-residue, high-protein diets are required. To maintain adequate nutrition. Vitamins and iron replacement are effective in maintaining nutritional requirements.

*Chemotherapy*
Antidiarrheal, anti-peristaltic, sedations, and corticosteroids are beneficial. Except for specific septic conditions e.g abscesses, peritonitis, antibiotics are not used as they may aggravate the bowel condition.

*Surgery*
In severe forms of ulcerative colitis where toxic dilatation of the colon, perforation, or severe hemorrhage are manifestations, surgical intervention becomes a consideration in the management of the patient.

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