ULCERATIVE COLITIS (Robbins pp 818)

Some obvious differences to Crohn’s include:

1) non-granulomatous,

2) no skip lesions,

3) affects only mucosa + submucosa,

4) affects proximally from rectum.

Epidemiology: peak incidence btw 25-30 & 70-80 year olds. Whites affected more, females affected more. Incidence of 4-12/100K.

Macroscopy:

1) mucosal ulcers ≫ friable mucosa,

2) pseudopolyps,

3) no mural thickening, with normal serosa,

4) no skip lesions,

Microscopy: Similar to Crohn’s disease:

1) Mucosal inflammation ≫ neutrophils infiltrate epithelium ≫ crypt abscesses,

2) chronic inflammation ≫ atrophy ≫ submucosal fibrosis,

3) dysplastic epithelium

Clinical features/Treatment:

1) bloody mucoid diarrhea episodes,

2) relapsing attacks between asymptomatic periods,

3) lower abdominal cramps.

Treatment is: local enema with surgical removal of colon. Regular colonoscopy with biopsy for dysplasia.

Sequelae:

1) Toxic megacolon (i.e.: inflammation extends to muscle layer and shuts down neuromuscular function),

2) malignancy (20-30x),

3) Extraintestinal diseases: primary sclerosing cholangitis, uveitis, arthritis.

Category: Pathology Notes