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-#redirect [[Inflammatory_bowel_disease#Ulcerative_colitis]]
+'''Ulcerative colitis''', abbreviated '''UC''', is a type of [[inflammatory bowel disease]].
+==General==
+*May be associated with ''[[toxic megacolon]]''.
+Epidemiology:
+*Associated with ''[[primary sclerosing cholangitis]]''.
+*[[Appendicitis]] is considered protective against UC.<ref name=pmid19685454>{{Cite journal  | last1 = Beaugerie | first1 = L. | last2 = Sokol | first2 = H. | title = Appendicitis, not appendectomy, is protective against ulcerative colitis, both in the general population and first-degree relatives of patients with IBD. | journal = Inflamm Bowel Dis | volume =  | issue =  | pages =  | month = Aug | year = 2009 | doi = 10.1002/ibd.21064 | PMID = 19685454 }}</ref><ref name=pmid19273505>{{Cite journal  | last1 = Timmer | first1 = A. | last2 = Obermeier | first2 = F. | title = Reduced risk of ulcerative colitis after appendicectomy. | journal = BMJ | volume = 338 | issue =  | pages = b225 | month =  | year = 2009 | doi =  | PMID = 19273505 }}</ref>
+*[[Smoking]] is protective; the opposite is true for [[Crohn's disease]].<ref name=pmid19273505/>
+==Gross==
+*Conventionally considered to be contiguous, i.e. no "skip lesions", with rectal involvement being most severe.
+*Dependent on the study one reads... rectal sparing may be seen in 15% of UC patients.<ref>{{cite journal |author=Bernstein CN, Shanahan F, Anton PA, Weinstein WM |title=Patchiness of mucosal inflammation in treated ulcerative colitis: a prospective study |journal=Gastrointest. Endosc. |volume=42 |issue=3 |pages=232-7 |year=1995 |month=September |pmid=7498688 |doi= |url=}}</ref>
+==Microscopic==
+Features:
+*Inflammation:
+**Active:
+***Neutrophils:
+****Intraepithelial ([[cryptitis]]).†
+****Clusters in crypts ([[crypt abscesses]]).
+****Erosions.
+**Chronic:
+***Architectural distortion.
+***Basal plasmacytosis.
+***Foveolar metaplasia.
+***Paneth cell metaplasia (distal).
+**Lack of [[granulomas]].
+*Mucin depletion - common in UC.<ref name=pmid2318990>{{Cite journal  | last1 = McCormick | first1 = DA. | last2 = Horton | first2 = LW. | last3 = Mee | first3 = AS. | title = Mucin depletion in inflammatory bowel disease. | journal = J Clin Pathol | volume = 43 | issue = 2 | pages = 143-6 | month = Feb | year = 1990 | doi =  | PMID = 2318990 }}</ref>
+Notes:
+*†Neutrophils are usually numerous in the lamina propria in minimal/mild active inflammation.
+*No full wall-thickness inflammation.
+*Epithelial apoptosis correlated with inflammation.<ref name=pmid19958058>{{Cite journal  | last1 = Seidelin | first1 = JB. | last2 = Nielsen | first2 = OH. | title = Epithelial apoptosis: cause or consequence of ulcerative colitis? | journal = Scand J Gastroenterol | volume = 44 | issue = 12 | pages = 1429-34 | month =  | year = 2009 | doi = 10.3109/00365520903301212 | PMID = 19958058 }}</ref>
+DDx:
+*[[Crohn's disease]].
+*[[Infectious colitis]].
+*[[Ischemic colitis]].
+*[[Diversion colitis]].
+==Sign out==
+<pre>
+SIGMOID COLON, BIOPSY:
+- MODERATE ACTIVE COLITIS WITH CHRONIC CHANGES, SEE COMMENT.
+- NEGATIVE FOR DYSPLASIA.
+COMMENT:
+No granulomata are identified. The sampled mucosa is diffusely inflamed. Crypt drop-out and
+architectural distortion are present.
+The findings are consistent with inflammatory bowel disease; however, an infectious etiology
+should be considered as a possibility.
+</pre>
+<pre>
+SIGMOID COLON, BIOPSY:
+- MILD ACTIVE COLITIS, SEE COMMENT.
+- NEGATIVE FOR DYSPLASIA.
+COMMENT:
+No granulomata are identified.
+</pre>
+<pre>
+A. RIGHT COLON, BIOPSY:
+- MODERATE ACTIVE COLITIS, SEE COMMENT.
+- NEGATIVE FOR DYSPLASIA.
+B. LEFT COLON, BIOPSY:
+- MODERATE-TO-SEVERE CHRONIC ACTIVE COLITIS, SEE COMMENT.
+- NEGATIVE FOR DYSPLASIA.
+COMMENT:
+No granulomata are identified. The mucosa is diffusely inflamed. Architectural distortion
+is present in the left colon.  The findings are consistent with ulcerative colitis;
+however, an infectious etiology should be considered as a possibility.
+</pre>
+<pre>
+RECTUM, BIOPSY:
+- MODERATE DIFFUSE CHRONIC ACTIVE PROCTITIS.
+- NEGATIVE FOR DYSPLASIA.
+COMMENT:
+No definite granulomata are identified. Crypt drop-out is present.
+Within the proper clinical context, these are findings of
+inflammatory bowel disease.
+</pre>
+===Inactive disease===
+<pre>
+SIGMOID COLON, BIOPSY:
+- CHRONIC COLITIS, SEE COMMENT.
+- NEGATIVE FOR ACTIVE COLITIS.
+- NEGATIVE FOR DYSPLASIA.
+COMMENT:
+The sections show chronic changes (basal plasmacytosis, marked crypt architectural
+distortion, crypt branching); however, no active colitis is present. Also, lamina propria
+neutrophils, which are often easy to identify in an active colitis, are not apparent.
+Appreciable numbers of lamina propria eosinophils are present and focally intraepithelial.
+No granulomas are identified. Clinical correlation is required.
+</pre>
+===Surveillance===
+<pre>
+A. ASCENDING COLON, BIOPSY:
+- COLONIC MUCOSA WITHOUT APPARENT PATHOLOGY.
+- NEGATIVE FOR ACTIVE COLITIS.
+- NEGATIVE FOR DYSPLASIA.
+B. TRANSVERSE COLON, BIOPSY:
+- COLONIC MUCOSA WITHOUT APPARENT PATHOLOGY.
+- NEGATIVE FOR ACTIVE COLITIS.
+- NEGATIVE FOR DYSPLASIA.
+C. DESCENDING COLON, BIOPSY:
+- COLONIC MUCOSA WITHOUT APPARENT PATHOLOGY.
+- NEGATIVE FOR ACTIVE COLITIS.
+- NEGATIVE FOR DYSPLASIA.
+D. SIGMOID COLON, BIOPSY:
+- COLONIC MUCOSA WITHOUT APPARENT PATHOLOGY.
+- NEGATIVE FOR ACTIVE COLITIS.
+- NEGATIVE FOR DYSPLASIA.
+E. RECTUM, BIOPSY:
+- RECTAL MUCOSA WITHOUT APPARENT PATHOLOGY.
+- NEGATIVE FOR ACTIVE PROCTITIS.
+- NEGATIVE FOR DYSPLASIA.
+COMMENT:
+Morphologically benign lymphoid aggregates are found focally. No granulomas are
+identified. Minimal architectural changes are seen focally.
+</pre>
+<pre>
+A. CECUM, BIOPSY:
+- QUIESCENT INFLAMMATORY BOWEL DISEASE.
+- NEGATIVE FOR DYSPLASIA.
+B. ASCENDING COLON, BIOPSY:
+- QUIESCENT INFLAMMATORY BOWEL DISEASE.
+- NEGATIVE FOR DYSPLASIA.
+C. COLON, HEPATIC FLEXURE, BIOPSY,
+- QUIESCENT INFLAMMATORY BOWEL DISEASE.
+- NEGATIVE FOR DYSPLASIA.
+D. TRANSVERSE COLON, BIOPSY:
+- QUIESCENT INFLAMMATORY BOWEL DISEASE.
+- NEGATIVE FOR DYSPLASIA.
+E. COLON, SPLENIC FLEXURE, BIOPSY:
+- QUIESCENT INFLAMMATORY BOWEL DISEASE.
+- NEGATIVE FOR DYSPLASIA.
+F. DESCENDING COLON, BIOPSY:
+- QUIESCENT INFLAMMATORY BOWEL DISEASE.
+- NEGATIVE FOR DYSPLASIA.
+G. SIGMOID COLON, BIOPSY:
+- QUIESCENT INFLAMMATORY BOWEL DISEASE.
+- NEGATIVE FOR DYSPLASIA.
+H. RECTUM, BIOPSY:
+- QUIESCENT INFLAMMATORY BOWEL DISEASE.
+- NEGATIVE FOR DYSPLASIA.
+COMMENT:
+No granulomas are identified. Mild architectural distortion is present. No active
+inflammation is identified. Scattered mucosal lymphoid nodules with germinal center
+formation are present.
+</pre>
+===Granulomas and inflamed crypts - clinically UC===
+<pre>
+A. CECUM, BIOPSY:
+- ACTIVE CECITIS, MILD.
+- SMALL MUCOSAL GRANULOMAS, SUPERFICIAL, SEE COMMENT.
+- NEGATIVE FOR DYSPLASIA.
+...
+COMMENT - PART A:
+The small granulomas are mucosal and near, but not all adjacent to, inflamed crypts; this
+finding raises the possibility of Crohn's disease. It should be noted that mucosal
+granulomas may be seen in ulcerative colitis beside inflamed crypts.
+COMMENT - GENERAL:
+The inflammation is diffuse and chronic changes are seen throughout. Distal paneth cell
+metaplasia is present. The diffuse nature of the inflammation would be more in keeping with
+ulcerative colitis. Clinical correlation is required.
+</pre>
+===Micro===
+The sections show focal intraepithelial neutrophils (cryptitis).  No crypt abscesses are identified. Granulation tissue is present. There is focal Paneth cell metaplasia and foveolar metaplasia. No granulomata are identified.
+==See also==
+*[[Inflammatory bowel disease]].
+*[[Crohn's disease]].
+==References==
+{{Reflist|2}}
 [[Category:Diagnosis]]
+[[Category:Gastrointestinal pathology]]

Difference between revisions of "Ulcerative colitis"

Ulcerative colitis (view source)

Revision as of 16:55, 21 February 2015

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