Ulcerative+Colitis

//Western Diagnosis// Inflammatory ulcerative bowel disease 1. only in colonic mucosa

Etiology
1. see Crohn's Disease: a. but cigarette smoking decreases risk

Epidemiology
1. familial tendency less than CD 2. peaks at ages 15-30 and 50-70

Pathology
1. usually begins in rectosigmoid area a. extends proximally 2. degeneration - infiltration with leukocytes - ulceration

Signs & Symptoms
1. intermittent bloody diarrhea 2. abdominal cramps 3. commonly insidious onset of inc urge to defecate, mild cramps, blood and mucous in stools: may have sudden onset of fulminant disease ---violent diarrhea, high fever, toxemia 5. often have rectal involvement: ulcerative proctitis 6. hemorrhage 7. extraintestinal manifestations ---peripheral arthritis, episcleritis, erythema nodosum - fluctuate with disease ---ankylosing spondylitis, sacroiliitis, uveitis - independent course from disease ---spondylitis and uveitis may have genetic overlap with UC ---primary sclerosing cholangitis 8. inc risk of colon CA - the further proximal the higher the risk

Diagnosis
1. history 2. stool examination 3. sigmoidoscopy 4. colonoscopy 5. plain films of abdomen to show extent 6. barium enema usually not done due to risk of perforation

Prognosis
1. chronic with repeated exacerbations and remissions 2. fulminating disease with complications in 10% of those with rapid initial attack 3. 10% recover completely from a single attack 4. highest CA risk if entire colon involved and disease present for >10 years 5. CA risk significantly inc if colitis proximal to sigmoid colon

Treatment
1. corticosteroids 2. sulfasalazine: serious side effects - blood dyscrasias, anemia, colitis 3. surgery ---elemental - IV of predigested enzymes ---white rice & salmon for a while ---food allergies ---EPA 5 gm/d ---zinc 30 mg/d ---beta carotene (mixed carotinoids) ---glutamine 3-12 gm/d ---quercetin/hesperidin ---vit. C, E ---Seacure - simplified whitefish protein high in omega 3. has highly successful clinical results
 * diet**
 * supplements**