Skip to Main Content

Source: Hemstreet, BA. Inflammatory Bowel Disease. In: DiPiro, JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM. Pharmacotherapy: A Pathophysiologic Approach. 8th ed. http://accesspharmacy.com/content.aspx?aid=7978181. Accessed May 31, 2012.

  • Idiopathic inflammatory bowel disease (IBD) manifesting as mucosal inflammation confined to rectum and colon.

  • Inflammation of mucosa and submucosa of rectum and colon
  • Extensive mucosal damage
  • Complications—Local
    • Hemorrhoids
    • Anal fissures
    • Perirectal abscesses
    • Toxic megacolon
      • Major complication
      • Severe condition that occurs in up to 7.9% of UC patients admitted to hospitals.
      • Symptoms:
        • High fever
        • Tachycardia
        • Distended abdomen
        • Elevated white blood cell count
        • Dilated colon
    • Colonic perforation
    • Colonic hemorrhage
    • Colon cancer
      • Increased risk as compared to general population.
      • Risk increases as length of UC history increases.
  • Complications—Systemic
    • Hepatobiliary
      • Occur in approximately 11% of patients with UC
        • Fatty liver
        • Pericholangitis
        • Chronic active hepatitis
        • Cirrhosis
        • Sclerosing cholangitis
        • Cholangiocarcinoma
        • Gallstones
    • Arthritis
      • Asymmetric and migratory
    • Ocular
      • Occur in approximately 10% of patients with UC
        • Iritis
        • Uveitis
        • Episcleritis
        • Conjunctivitis
    • Dermatologic and mucosal
      • Occur in 5–10% of patients with UC
        • Erythema nodosum
        • Pyoderma gangrenosum
        • Aphthous stomatitis

  • Highly variable
    • Intermittent bouts of illness after varying intervals of no symptoms commonly seen.
    • Disease often confined to the rectum (proctitis)
  • Presentation (Table 1)
    • Mild abdominal cramping with frequent small-volume bowel movements to profuse diarrhea
  • Disease classification
    • Mild (two-thirds of patients)
      • Fewer than 4 stools daily
      • With or without blood
      • No systemic disturbance
      • Normal erythrocyte sedimentation rate (ESR)
    • Moderate
      • More than 4 stools per day
      • Minimal systemic disturbance
    • Severe
      • More than 6 stools per day with blood
      • Evidence of systemic disturbance as shown by:
        • Fever
        • Tachycardia
        • Anemia
        • ESR >30
    • Fulminant
      • More than 10 stools per day with continuous bleeding
        • Transfusions required
      • Toxicity
      • Abdominal tenderness
      • Colonic dilation

Table 1. Clinical Presentation of Ulcerative Colitis

Laboratory Tests

  • Stool examination
  • ESR

Imaging

  • Barium radiographic contrast studies

Diagnostic Procedures

  • Biopsy
  • Sigmoidoscopy
  • Colonoscopy

  • Resolution of acute inflammatory processes
  • Resolution of attendant complications (e.g., fistulas or abscesses)
  • Alleviation of ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.