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Pathology – Ulcerative Colitis
Ulcerative colitis is an idiopathic inflammatory bowel illness defined by inflammation confined to the mucosa of the large intestine, invariably involving the rectum and extending proximally in a continuous manner across a variable distance.
Epidemiology: Rare occurrence. • Significant occurrence between the ages of 15 and 25.
Aetiology and Pathogenesis • Believed to result from an aberrant mucosal immune response to luminal microorganisms. The genetic association is less robust than that of Crohn's disease. • Smoking seems to reduce the risk of ulcerative colitis (UC). • An atypical yet frequently validated observation is the preventive influence of appendectomy on the later onset of ulcerative colitis (UC).
Presentation • Recurrent episodes of hematochezia, frequently accompanied by urgency and tenesmus.
Macroscopy • Erythematous mucosa exhibiting a friable, degraded surface accompanied by hemorrhage. Inflamed mucosa may develop polypoid projections (inflammatory polyps). The disease invariably affects the rectum and extends continually to involve a varying extent of the colon.
Histopathology • Biopsies reveal widespread mucosal inflammation accompanied by cryptitis and the production of crypt abscesses. Inflammation is typically more pronounced distally. Resection specimens exhibit widespread inflammation confined to the mucosal layer. Inflammatory polyps may be present. In cases of severe acute ulcerative colitis, inflammation may extend into the submucosa or muscular layers; however, the mucosal layer remains the site of most inflammation.
Prognosis: Generally favorable with intervention. • Elevated risk of colorectal cancer necessitates the recommendation of surveillance colonoscopy several years post-diagnosis. Extragastrointestinal manifestations encompass enteropathic arthropathy, primary sclerosing cholangitis?erythema nodosum,pyoderma gangrenosum,uveitis, and AA amyloidosis.
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