PRESENTED BY
K. Kavya Sri
ULCERATIVE COLITIS 256217882011
Pharm. D (5th year)
INTRODUCTION:
• Ulcerative colitis is an inflammatory bowel disease that affects large intestine, causing irritation,
inflammation and ulcers in the colon.
• It is a long life illness that has a profound emotional & social impact on the affected patients.
• Ulcerative colitis affects the innermost lining of the large intestine and rectum.
• Symptoms usually develop over time rather than suddenly.
• Ulcerative colitis can be debilitating & sometimes can lead to life threatening complications.
• While it has no cure, treatment can greatly reduce signs and symptoms of the disease and bring out
long term remission.
TYPES OF ULCERATIVE COLITIS:-
Doctors often classify UC according to its location. Types of UC include:
• Ulcerative proctitis:- Inflammation is confined to the area closest to the anus (rectum), and rectal
bleeding may be the only sign of the disease.
• Proctosigmoiditis:- Inflammation involves the rectum and sigmoid colon — the lower end of the
colon. Signs and symptoms include bloody diarrhoea, abdominal cramps and pain, and an inability to
move the bowels in spite of the urge to do so (tenesmus).
• Left-sided colitis:- Inflammation extends from the rectum up through the sigmoid and descending
colon. Signs and symptoms include bloody diarrhoea, abdominal cramping and pain on the left side,
and urgency to defecate.
• Pancolitis:- This type often affects the entire colon and causes bouts of bloody diarrhoea that may be
severe, abdominal cramps and pain, fatigue, and significant weight loss.
EPIDEMIOLOGY:-
• In the United States, about 1 million people are affected with ulcerative colitis (UC).
• 4-12 cases per 100,000 people, and the prevalence rate is 35-100 cases per 100,000 people.
• Ulcerative colitis is three times more common than Crohn’s disease.
• Ulcerative colitis is quiet common in India and about 1 million cases are observed every year.
• Ulcerative colitis is slightly more common in women compared to men.
• Race: Caucasians have the highest risk of UC although anyone of any race can get it.
• People of Ashkenazi Jewish descent have an even higher risk of UC.
• Age: Ulcerative colitis usually begins before age 30 or people may develop UC at any age.
ETIOLOGY:-
• The exact cause of ulcerative colitis (UC) is unknown, but certain factors have been found to be
associated with the disease, and some hypotheses have been presented.
• Etiologic factors potentially contributing to ulcerative colitis include genetic factors, immune system
reactions, environmental factors, nonsteroidal anti-inflammatory drug (NSAID) use, low levels of
antioxidants, psychological stress factors, a smoking history, and consumption of milk products.
• Certain types of food composition and the use of oral contraceptives may be associated with this
condition.
• The current hypothesis is that genetically susceptible individuals have abnormalities of the humoral
and cell-mediated immunity or generalized enhanced reactivity against commensal intestinal bacteria
and that this dysregulated mucosal immune response predisposes to colonic inflammation.
• A family history of ulcerative colitis (observed in 1 in 6 relatives) is associated with a higher risk for
developing the disease.
• Immune reactions that compromise the integrity of the intestinal epithelial barrier may contribute to
ulcerative colitis.
ETIOLOGY:-
• Environmental factors also play a role. For example, sulfate-reducing bacteria, which produce
sulfides, are found in large numbers in patients with ulcerative colitis, and sulfide production is higher
in patients with ulcerative colitis than in other people.
• Sulfide production is even higher in patients with active ulcerative colitis than in patients in
remission.
• NSAID use is higher in patients with ulcerative colitis than in control subjects, and one third of
patients with an exacerbation of ulcerative colitis report recent NSAID use.
• Other factors that may be associated with ulcerative colitis include the following:
1. Vitamins A and E, both considered antioxidants, are found in low levels in as many as 16% of
children with ulcerative colitis exacerbation.
2. Psychological and psychosocial stress factors can play a role in the presentation of ulcerative colitis
and can precipitate exacerbations.
3. Smoking is negatively associated with ulcerative colitis. This relationship is reversed in Crohn
disease.
4. Milk consumption may exacerbate the disease.
Common symptoms of UC include:
• abdominal pain
• increased abdominal sounds
• bloody stools
• diarrhoea
CLINICAL • fever
PRESENTATION:- • rectal pain
• weight loss
• Malnutrition
• Others: joint pain, joint swelling, nausea &
decreased appetite, skin problems, mouth sores, eye
inflammation.
PATHOGENESIS
Tests to diagnose UC often include:
• Stool test:- A doctor examines your stool for certain
inflammatory markers, blood, bacteria, and parasites.
• Endoscopy:- A doctor uses a flexible tube to examine
your stomach, esophagus, and small intestine.
• Colonoscopy:- This diagnostic test involves insertion of
a long, flexible tube into your rectum to examine the
inside of your colon.
• Biopsy:- A surgeon removes a tissue sample from your
DIAGNOSIS:- colon for analysis.
• CT scan:- This is a specialized X-ray of your abdomen
and pelvis.
• Blood tests are often useful in the diagnosis of UC. A
complete blood count looks for signs of anaemia (low
blood count).
• Other tests indicate inflammation, such as a high level of
C-reactive protein and a high sedimentation rate. Your
doctor may also order specialized antibody tests.
TREATMENT
ALGORITHM:
A female patient of 12 years old was admitted in the
paediatrics ward with the chief complaints of :
• Frequent passage of blood mixed stools for last 2
months (8-10 times a day) associated with low grade
intermittent fever.
• Other symptoms- anorexia, tenesmus, lower
SUBJECTIVE abdominal pain, significant weight loss and pain in
large joints.
DATA:- • No past medical history.
• No past medication history
• No family history
• No social history
OBJECTIVE DATA:-
Complete blood picture:-
PARAMETERS VALUES
haemoglobin 9.6 g/dl
neutrophils 74.1%
Erythrocyte sedimentation rate:-
ESR 69 mm/hr
URINE ANALYSIS:-
PUS CELLS present
LIVER FUNCTION TESTS:-
ALBUMIN 1.9
SERUM ELECTROLYTES:-
SERUM POTASSIUM 3.1 mmols/L
• CRP:- 4.08 mg/dl
• ANA:- negative
• Stool microscopy:- pus cells
RADIOLOGICAL REPORTS:-
• Chest X ray:- normal
OTHER • Ileo- colonoscopy:- multiple ulcerative punched out
lesions with necrotic and haemorrhagic surface
INVESTIGATIONS:- noted throughout the length of colon in patchy
distribution.
• Colonic biopsy:- focal surface exosion and focal
ccyptitis, increased infiltration of lymphocytes,
polymorphs, eosinophils in lamina propria
degenerative and regenerative changes
characterized by nuclear hyperchromatism,
stratification and depletion and cytoplasmic mucin
of lining of epithelium.
ASSESSMENT:-
Based on the above subjective and objective data the patient was diagnosed
with ulcerative colitis.
TREATMENT CHART:-
TRADE NAME GENERIC ROUTE DOSE FREQUENCY DAY-1 DAY-2 DAY-3 DAY-4 DAY-5 DAY-6 DAY-7
NAME
Inj. CIPROFLOX Ciprofloxacin IV 200 mg BD
Inj. Metronidazole Metronidazole IV 400 mg BD
Inj. Hydrocortisone IV 100 mg TID
HYDROCORT
[Link] Mesalamine PO 400 mg OD
[Link] Ciprofloxacin PO 500 mg OD
T. FLAGYL metronidazole PO 200 mg BD
• No restrictive diet
• Regular low- moderate intensity activity,
including cardiovascular and resistance
exercise has been shown to improve quality
of life.
PATIENT • Do not drink carbonated drinks.
COUNSELLING:- • Drink more liquids.
• Eat more frequent and smaller meals.
• Do not eat high fibre foods such as
popcorn, vegetable skins and nuts while
you have symptoms.
THANK YOU
