Ulcerative colitis is an inflammatory disease of chronic nature, which is more
pronounced in the colon and upper gastrointestinal tract. This chronic
... [Show More] inflammation has a nature
of remitting and relapsing. It highly affects the innermost lining of the colon and rectum.
Symptoms are not sudden but appear over prolonged periods. The exact cause is unknown. It is
believed that immune system malfunction may be a possible cause. In this paper, there will be an
overview of a female patient suffering from Ulcerative colitis.
Pathophysiology of Disease Process
Ulcerative Colitis often remains confined to the rectum and can spread contiguously and
proximally. It involves the defects found in the immune response, epithelial barrier, and
leukocyte recruitment along with the micro flora of the colon. The defect in the epithelial barrier
causes increased uptake of luminal antigens. There is T helper cell response that exerts a
cytotoxic response against the epithelial cells. There is distortion of crypt architecture and there
is inflammation of crypts, which is called cryptitis. The damage to the epithelial lining results in
formation of Frank crypt abscesses. The lamina propria forms inflammatory cells that cause
damage to the lining and there is a formation of Pseudopolyps. (Paramsothy, 2017)
Risk Factors
The causes of UC include infectious, genetics, immunological and environmental triggers that
form in response to triggers. This disease equally affects the same number of men and women.
The risk factors for Ulcerative colitis include family history, race, ethnicity, Smoking, NSAID
medications, utilization of processed food, mutations and age. It usually begins before the age of
30 but the occurrence is not limited to any age group. Some people might not develop it until the
age of 60. It can occur in any race, but whites have the highest probability of having it. Strong
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ULCERATIVE COLITIS CASE STUDY
family history is another factor that can put a person at a higher risk of this disease. (Rubin,
2019)
Morphology
The extent of this disease comprises of variation and may involve only the rectum
(ulcerative proctitis), the left side of the colon to the splenic flexure, or the entire colon
(pancolitis). Histologically, the severity of the disease may also be quite variable, which ranges
from minimal to florid ulceration and dysplasia. Carcinoma may develop. The lesion of
ulcerative colitis is the crypt abscess, in which the epithelium of the crypt breaks down and the
lumen fills with polymorphonuclear cells. The lamina propria is infiltrated with leukocytes. As
the crypts are destroyed, normal mucosal architecture is lost and resultant scarring shortens and
can narrow the colon.(Sandborn, 2016)
Pathogenesis
The pathogenesis of ulcerative colitis is still unknown. Many theories have been proposed that
show vascular impairment, bacterial-immunological interactions, and allergic or hypersensitivity
reactions. One hypothesis suggests that these triggers are microbial pathogens, which have not
been identified. According to this theory, the immune response in IBD is an appropriate but
ineffective response to these pathogens. Diet is a major source of antigens in the intestinal lumen.
Dietary antigens have the capacity to trigger immune responses. One of the foods implicated in
the pathogenesis of UC is cow's milk. Patients with UC disease show an increased incidence of
antibodies to cow's milk protein. In patients with IBD, cow's milk proteins and other dietary
antigens have abnormal access to the lamina propria because of the defect in the epithelial cell
monolayer caused by inflammation. (Smillie, 2019)
Clinical Features
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ULCERATIVE COLITIS CASE STUDY
The location of the disease in the gastrointestinal tract can alter the clinical features in a person.
The common features include bloody diarrhea, abdominal pain, frequent bowel movements,
urgency. Progression of the disease may cause Frank crypt abscesses, Pseudopolyps and cryptitis.
Lab tests reveal malabsorption, anemia and dehydration. Severe cases include symptoms
like four or fewer stools per day with or without blood. Severe disease has more than 10 stools
per day with severe cramps and continuous bleeding.
Patient History and Physical Assessment
Biographic Data
Name: S. Grey Age: 43
Address: Nigerian Gender: Female
Marital Status: Single Race: Black
Occupation: lawyer [Show Less]