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Inflammatory Bowel Disease Ulcerative colitis (UC)

Inflammatory Bowel Disease Ulcerative colitis (UC). Kristina Blaslov Mentor: A. Žmegač Horvat. Epidemiology. Highest incidence in Europe, United Kingdom, North America . Etiology and Pathogenesis. Consensus hypothesis: genetically predisposed individuals + exogenous factors +

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Inflammatory Bowel Disease Ulcerative colitis (UC)

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  1. Inflammatory Bowel Disease Ulcerative colitis (UC) Kristina Blaslov Mentor: A. Žmegač Horvat

  2. Epidemiology • Highest incidence in Europe, United Kingdom, North America

  3. Etiology and Pathogenesis • Consensus hypothesis: genetically predisposed individuals + exogenous factors + host factors ↓ dysregulated mucosal immune function (modified by specific environmental factors )

  4. Pathology • Macroscopic features: - mild inflammation - moderate disease - long-standing disease - fulminant disease

  5. Microscopic features -process limited to the mucosa and superficial submucosa, with deeper layers unaffected (except in fulminant disease!)

  6. Clinical presentation • Signs and symptoms: - diarrhea - rectal bleeding - tenesmus - passage of mucus - abdominal pain - other symptoms: anorexia, nausea, vomiting, fever, weight loss

  7. Laboratory - rise in acute-phase reactants - erythrocyte sedimentation rate - decrease in hemoglobin - leukocytosis - pANCAs • Endoscopy (not in acute phase!) - sigmoidoscopy - colonoscopy • Radiology - barium enema

  8. Diagnosis relies on the patient's history, clinical symptoms, negative stool examination for bacteria, C. difficile toxin, and ova and parasites; sigmoidoscopic appearance and histology of rectal or colonic biopsy specimens!

  9. Extraintestinal manifestations: - dermatologic - erythema nodosum, pyoderma gangrenosum - rheumatologic - peripheral arthritis, ankylosing spondylitis - ocular - conjunctivitis, uveitis/iritis, episcleritis - hepatobiliary - steatosis, PSC - urologic - calculi, ureteral obstruction, fistulas - metabolic bone disorders - low bone mass

  10. Treatment

  11. Nutritional therapies : - total parenteral nutrition • Surgical therapy - indications: intractable disease, fulminant disease, toxic megacolon, colonic perforation, massive colonic hemorrhage, colonic obstruction, colon cancer prophylaxis, colon dysplasia or cancer

  12. References: • Harrison’s Principles of Internal Medicine, 17 th edition

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