Ulcerative Colitis

Pancolitis

Starts at rectum

Retrograde into colon

Continuous

x Skip lesions

10% Backwash ileitis (mild mucosal inflamm of distal ileum)

Epidemiology
*White
*20-25

Symptoms
Worse Pn than Crohn's
Acute appendicitis
Diarrhoea - Haem/Mel/Mucus
Toxic megacolon (toxin damage of Nplexus and MPp = shutdown of neuromuscular function = distension & gangerene. W/o intervention = perforation & sepsis)

Pathology
Limited to mucosa
Pseudopolyps (extensive superficial ulceration = small islands of residual mucosa resembling polyps)
x transmural
x serosal inflammation
x fat wrapping
x fissuring
x fistulae
x thickening

Micro
Diffuse mucosal ulceration
Cryptitis (lim to muc)
Crypt abscesses (lim to muc)
Crypt distortion (long-standing inflammation)
x Granulomas

Cx
Increased risk - dysplasia & colonic carcinoma
Up risk with time
10yrs = x20R
35yrs = 30%

Prevention
10yrly colonoscopies (NB if init BP -ve  or dysp = lower risk of Ca)