Ulcerative colitis

Ulcerative Colitis (UC) is a chronic, relapsing-remitting inflammatory bowel disease (IBD) that primarily affects the colon (large intestine) and rectum.

It leads to continuous mucosal inflammation, resulting in ulcers and bleeding.

Pathophysiology

Triggering Event → A combination of genetic, immune, and environmental factors triggers an abnormal immune response.
Immune Activation → Overactive T-cells (mainly Th2 cells) cause persistent inflammation.
Mucosal Damage → Chronic inflammation leads to:
- Continuous ulceration of the colonic mucosa.
- Loss of the protective mucus layer.
- Increased permeability, leading to diarrhea and bleeding.
Disease Progression → Leads to complications like strictures, toxic megacolon, and colorectal cancer.

Clinical Features

A. Symptoms

Gastrointestinal Symptoms
- Chronic bloody diarrhea (hallmark symptom)
- Mucus in stool
- Urgency and tenesmus (feeling of incomplete evacuation)
- Abdominal pain (mostly lower left quadrant)
- Weight loss (severe cases)
Systemic Symptoms (in severe cases)
- Fatigue, fever, anemia
- Malnutrition due to nutrient loss

B. Extraintestinal Manifestations (EIMs)

UC is not limited to the intestine; it can affect other organs:

Joints: Arthritis, ankylosing spondylitis
Skin: Erythema nodosum, pyoderma gangrenosum
Eyes: Uveitis, episcleritis
Liver: Primary sclerosing cholangitis (PSC)

Classification & Severity

Based on Location
1. Proctitis: Only rectum involved (mildest form).
2. Left-sided colitis: Involves rectum, sigmoid, and descending colon.
3. Pancolitis: Involves the entire colon (severe disease).

Based on Severity (Truelove and Witts Criteria)

Feature	Mild	Moderate	Severe
Stool Frequency	< 4/day	4-6/day	> 6/day with blood
Blood in Stool	Small amount	Moderate	Large amount
Fever	None	Possible	Yes (>37.5°C)
Heart Rate	Normal (<90 bpm)	Mildly elevated	>90 bpm
Hemoglobin	Normal	Low	Severely low

Ulcerative colitis

Pathophysiology

Clinical Features

A. Symptoms

B. Extraintestinal Manifestations (EIMs)

Classification & Severity

Based on Location

Based on Severity (Truelove and Witts Criteria)

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