Inflammatory Bowel Disease: Clinical Findings in Ulcerative Colitis
Authors: Yan Yu Amy Maghera Reviewers: Jennifer Au Danny Guo Jason Baserman Crystal Liu Danielle Chang Kerri Novak* * MD at time of initial publication
Inflammation is systemic, affecting:
Environmental Factors
Diet, bacteria/viruses, drugs
Genetic Susceptibility
Behavioral Factors:
In UC, smoking and appendectomy are actually protective (unknown reason)
Immune response against the GI tract. (Unclear mechanism, but thought to be mediated by cytokine release and neutrophil infiltration)
Inflammation of the GI tract epithelial lining
– Starting at the rectum and moves up the colon and is continuous (does not invade the small intestine)
– Inflammation affects the mucosal and submucosal only
Diarrhea, abdo pain and cramping causing avoidance of food
Weight loss
Apoptosis of GI tract mucosa
Transporter proteins responsible for Na+ reabsorption gradually disappear from the epithelium
Ulceration, into the anus, and more severe
Prolonged Bleeding – GI and anus
Anemia, often iron deficiency
Inflammation ↑ permeability of the blood vessels supplying the GI tract wall
Fluid leak out of capillaries into GI tract wall, causes edema and swelling
Swelling narrows the GI tract lumen, causing bowel obstruction
Inflammation, ulceration, or infection at the anus (all involve the RECTUM!)
Anal irritation stimulates autonomic and somatic nerves leading up to the brain, causing the pt to want to defecate
Tenesmus, urgency, frequency (feeling or urgency to defecate, but little stool is produced)
Joints Skin
Arthroplasty/ joint pain
Erythema nodosum, pyoderma gangrenosum
Mouth >5 canker sores
More sodium (and thus water) is retained in the GI tract lumen
Bloody Diarrhea, usually bloody due to anal bleeding and ulceration bleeding
Abdominal Cramping and pain (see Bowel Obstruction page for full mechanism)
Eyes (uvea, iris, sclera)
Liver Blood
Uveitis
Iritis, scleritis
Sclerosing Cholangitis
Autoimmune hemolytic anemia
Legend:
Pathophysiology
Mechanism
Sign/Symptom/Lab Finding
Complications
Re-Published May 5, 2019 on www.thecalgaryguide.com