Ulcerative inflammatory bowel disease is an idiopathic chronic inflammatory disease of the rectum and the colon that follows a class of backsliding and remittal. It is an inflammatory intestine disease, which is characterized by mucosal redness with crypt abscesses, ulcers and pseudopolyp formation. The chronic redness is limited to mucosa, sometime that is extended to submucosa. Ulcerative inflammatory bowel disease is a status that starts at the rectum and ends at some point in the colon. The affected country is uninterrupted ; there is no country of normal tissues between the affected countries. It is erstwhile definite diagnosing of ulcerative or Crohn ‘s can be established in which instance the term an indeterminate inflammatory bowel disease is used.
Epidemiology: – Ulcerative inflammatory bowel disease affects about 1 in 1000 people in the Western universe. First battalion incidence between the age of 10-40 twelvemonth ‘s, but may impact people of any age and 2nd extremum incidence at norm of 60 twelvemonth ‘s ( Bimodal distribution ) . The disease affects females and males. The geographic distribution of ulcerative inflammatory bowel disease is the highest incidence in The United Status, Canada, The United Kingdom. Higher incidence is seen in northern locations compared to southern locations in Europe and the United Status. The prevalence of ulcerative inflammatory bowel disease is greater among Ashkenazi Jews and decreases increasingly in other individual of Judaic descent, non-Jewish Caucasians, Africans, Hispanics and Asians, because familial susceptibleness is a factor associated with ulcerative colitis..
Mortality: – The consequence of ulcerative inflammatory bowel disease on mortality is ill-defined. Some surveies confirm that, mortality of patient with ulcerative inflammatory bowel disease is merely 12 % ( Viscido et al, 2001 ) . Although, mortality from ulcerative inflammatory bowel disease is decreased during the past 50 twelvemonth ‘s ( Sonnenbery,2007 ) . Therefore, it is thought that the disease chiefly affects quality of life non life span.
Causes and hazard factors: – Causes of ulcerative inflammatory bowel disease is still unknown. There are many factors including:
*Genetic factors proposing that the disease arise from combination of multiple cistrons abnormalcies, for illustration p35 cistron mutation,15 % increased hazard in 1st degree relation ( Medicine, 2010 ) .
*Environmental factors include the undermentioned: First, diet has been hypothesized to play function in pathogenesis of ulcerative inflammatory bowel disease, for illustration a diet with low in dietetic fiber may impact ulcerative inflammatory bowel disease incidence. Second, chest eating has been reported of protection in development of inflammatory intestine disease ( Klement et al. , 2004 ) .
*Auto immune disease, some beginnings list ulcerative inflammatory bowel disease as an autoimmune disease couple to malfunction of the immune system ( Odze, 2003 ) . However, surgical remotion of the big bowel frequently cures the disease, including the manifestation outside the digested system. This suggest that the cause of the disease is in colon itself and non in the immune system or some other portion of organic structure ( e Medicine, 2009 ) .
*Alternative theories proposing that the symptoms of the disease may be caused by toxic consequence of H sulfide in the bowel in patient with ulcerative inflammatory bowel disease. It may be caused by occlusion of in the capillaries of sub epithelial liner, and infiltration of the lamina propria with plasma cells.
* Appendectomy prior to age 20 for appendicitis and baccy usage both are protective against development of ulcerative inflammatory bowel disease.
*Psychological factors and socioeconomic factors, clinical aggravation has been found to be facilitated by life emphasis in ulcerative inflammatory bowel disease ( Novack et al. , 2006 )
Types of ulcerative inflammatory bowel disease: The different types of ulcerative inflammatory bowel disease are classified harmonizing to the location and extent of redness.
*Ulcerative proctitis refers to inflammation that is limited to the rectum ( Rectal hemorrhage ) .
*Procoto-sigmoiditis involves redness of the rectum and sigmoid colon ( Rectal hemorrhage ) .
*Left side inflammatory bowel disease involves redness that starts at rectum and extends up the left colon ( Bloody diarrhea, venters cramp, weight loss ) .
*Pancolitis refers to inflammation impacting the full colon ( Bloody diarrhea, abdominal hurting, weight loss, febrility and dark perspiration ) .
*Fulminated inflammatory bowel disease is rare, nevertheless it is terrible signifier of pancolitis ( Dehydration, terrible abdominal hurting, bloody diarrhoea and daze. They are at hazard of developing toxic megacolon ( Marked dilation of colon couple to severe redness ) , ensuing in colon rupture ( Perforation, peritoneal inflammation, abscesses and monolithic bleeding ) .
Ulcerative inflammatory bowel disease is divided into four phases harmonizing to gross pathology: –
*Acute phase is involved mucosal surface, which is wet and glowering from blood and mucous secretion, frequently is associated with petechial bleeding.
*Chronic phase shows assorted sized of irregular ulcers and elevated sessile ruddy nodules ( pseudopolyps ) .In this phase raise intuition of carcinoma ( 1 % of all colorectal carcinoma ) .
*More advanced phase is involved full intestine, shows fibrotic, narrowed and shortened.
*Quiescent phase shows no ulceration, but the mucous membrane shows wasting or sometimes appears grossly normal. It may be extended submucosal fat deposition.
Intestinal symptoms: – The most common symptoms of ulcerative inflammatory bowel disease are bloody diarrhoeal and abdominal hurting. Patient besides may see anemia, weariness, weight loss, loss of appetency, rectal hemorrhage, loss of organic structure fluid and nutrition.
Extra-intestinal symptoms: – These include the undermentioned: aphtous ulcer of oral cavity, oculus disease ( Iritis or uveitis ) , arthritis ( ancylosing spondylitis ) , erythema nodosum, deep venous thrombosis, autoimmune hemolytic anemia, clubbing and primary sclerosing cholangitis.
Differentiation diagnosing: –
*Crohn ‘s disease, morbific inflammatory bowel disease, *pseudomembranuos inflammatory bowel disease, ischaemic inflammatory bowel disease ( aged people ) , TB, colorectal glandular cancer.
Everyday probe: – The initial diagnostic workup for ulcerative inflammatory bowel disease includes the followers.
*A complete blood count is done to look into anemia ( iron lack anemia ) , which is hypochromic microcytic anemia ( low MCH, low MCV, low hemoglobin ) .
*Elevated of white blood cells, it is more than normal scope ( 4.300-10.800 cells/cmm ) .
*Thrombocytosis is high thrombocytes count, it is more than normal scope ( 150-400x 10/ L ) .
*Erythrocyte deposit rate is elevated = ( ? 18 mm/ hour ) .
*C-reactive protein is acute stage protein that is produced by liver during redness. It is elevated= ( ? 10mg/l ) .
*Electrolytes analysis and nephritic map trial are done, because chronic diarrhoea may be associated with hypokalemia, hypomagnesaemia and pre nephritic failure.
*Liver map trials are performed to test for bile canal engagement.
*Stool civilization to except parasites and morbific causes.
Diagnostic processs for ulcerative inflammatory bowel disease: – There are include the undermentioned.
Endoscopy and biopsies: – The best trial for diagnosing of ulcerative inflammatory bowel disease remains endoscopy.
*Full colonoscopy is extended from anus to the cecum, besides entry into terminal ileum is attempted merely if diagnosing of ulcerative inflammatory bowel disease is ill-defined and to distinguish between ulcerative inflammatory bowel disease and Crohn ‘s disease, because in some instances of ulcerative inflammatory bowel disease may be involve terminal ileum. Endoscopic happening in ulcerative inflammatory bowel disease include the undermentioned: loss of vascular visual aspect of the colon, erythematic or inflammation of the mucous membrane and crumbliness of the mucous membrane, superficial ulceration and pesudopolyps. Biopsies of mucous membrane are taken from different parts of colon to definitively diagnosing of ulcerative inflammatory bowel disease and differentiated from Crohn ‘s disease. The histology happening in ulcerative inflammatory bowel disease typically involves deformation of crypt architecture, redness of crypts ( cryptitis ) , blunt crypt abscesses, bleeding and inflammatory cells in lamina propria ( lymph cells, plasma cells ) . Acute phase shows accretion of neutrophil at base of crypts ( crypt abscesses ) . No granuloma is of import standard in differential diagnosing with Crohn ‘s disease. Mucosal capillary are dilated. Inflammation may stay above muscularis mucous membrane or widen to submucosa. Glands are progressive destroyed, marked lessening in cytol, mucous secretion, atrophic alterations and regenerative alterations, besides manifested by atomic expansion and increased mitotic activity. Other characteristic shows, ulcer is covered by non specific granulation tissue, pseudopolyps ( mostly granulation tissues assorted with inflamed and hyperaemic mucous membrane.
*Flexible sigmoidoscopy is extended from anus to sigmoid colon.
*Abdomen X beams are speedy, inexpensive, non invasive and an ten beam of venters that is indicated in acute venters conditions such as enteric obstructor, perforation, dilation ( Toxic megacolonic ) .
*Trans-abdominal ultrasound is a non-invasive mode that may be helpful in the diagnosing of inflammatory intestine disease, but it can non be used to separate between ulcerative inflammatory bowel disease and Crohn ‘s disease. It is used for naming bilious complication.
*CT has limited function in the diagnosing of unsophisticated ulcerative inflammatory bowel disease, nevertheless CT plays an first-class mode in the diagnosing of complication associated with disease.
*Barium clyster is particular type of x beam that uses Ba sulfate and air to sketch the liner of rectum and colon. The consequence can demo polyp, tumour, diverticulitis. Today, the utilizations of Ba clyster are rare due to the utilizations of endoscopy for naming. There is contraindication of utilizing Ba clyster in acute venters as complication of UC.
*Radio-nuclide surveies are utile in picturing disease activity and the extent of disease and in supervising the response to therapy. It is utile in instance of fulminant inflammatory bowel disease
* Serology trial is performed in about 20 % of instances of UC, overlapping symptoms, radiographic and histological characteristics make the differential diagnosing hard. It is of import to accurately distinguish between two diseases ulcerative inflammatory bowel disease and Crohn ‘s disease, because the direction of patient are different and ulcerative inflammatory bowel disease is more hazard for malignance. The usage of an inflammatory intestine disease serology panel that should be included the followers, Perinuclear anticytoplasmic antibodies ( PANCA ) and Saccharyomyces cerevisiac IgA nd IgG antibodies ( ASCA ) . Because, PANCA is prevailing in ulcerative inflammatory bowel disease and ASCA is more prevailing in Crohn ‘s disease. ASCA represent the immunologic marker corrected with Crohn ‘s disease, because their high specificity ( 80-95 % ) .
*Immunohistochemistry appraisal of ki67 and p53 look assists the diagnosing and scaling of ulcerative inflammatory bowel disease related dysplasia. Strong immunoreactivity for p53 that suggested diagnosing of dysplasia, besides suggested Ki67 staining above basal two tierce of the crypt in high class dysplasia ( HGD ) .
Complication: – There is significantly increased hazard of colorectal malignant neoplastic disease in patient with ulcerative inflammatory bowel disease after 10 twelvemonth ‘s if engagement in the splenetic flection, nevertheless those with lone procotitis or rectosigmoid it is normally have no increased hazard. It is recommended that patient have screening by colonoscopies with random biopsies to look for dysplasia after eight twelvemonth ‘s of disease activity.
Treatment: – The standard intervention for ulcerative inflammatory bowel disease is depended on the extent of engagement and disease badness. The end is to bring on remittal ab initio with medicine, followed by the disposal of care medicine to forestall a backsliding of the disease.
*Dietary alteration: Diet rich of fibers, avoiding dairy merchandises, avoiding natural vegetates and fruit, because they cause hurt to inflamed mucous membrane of colon.
*Supplement intervention: Iron tabular arraies for intervention of anemia, multivitamin.
*Anti diarrheal drugs: Such as Immodium, a physician must closely supervise the individual taking these anti-diarrheal drugs to avoid precipitating toxic megacolon.
*Anti-inflammatory drugs: Such as aminosalicytates, corticoids and immunosuppressive drugs. Besides anti tumour mortification factor ( Infliximabe ) .
*Surgical intervention: Surgical intervention can be exigency operation and elected operation. Emergency operation is performed in instances of bleeding, blunt perforation, break up inflammatory bowel disease or toxic megacolon and elected operation is performed in instances of patient is non response to intervention and documented or strongly suspected carcinoma. There are different types of surgical attacks such as proctocolectomy with ileostomy, Ileoanal anatomises and continent ileostomy.
Some probes are used for proctor of inflammatory intestine disease: –
*Concentration of tumour mortification factor alpha in stool is used as a marker of intestine redness in both ulcerative inflammatory bowel disease and Crohn ‘s disease.
*Measurement degree of neutrophli binding by Ig and titers of antineutrophli Ig in serum from patient with ulcerative inflammatory bowel disease and patient with ulcerative inflammatory bowel disease station colectomy by utilizing a fixed neutrophil enzyme linked immunosorbent check.
*Measurement of azotic oxide in ulcerative inflammatory bowel disease patient during colonoscopy, gas was aspirated from different parts of the colon and instantly analyzed by a chemiluminescence technique.