Pathophysiology of Ulcerative Colitis

Pathophysiology of Ulcerative Colitis

Introduction (Criteria 1 & 2):

Ulcerative colitis affects the colon or the large intestines and involves the inflammation of the lining of the colon leading to ulcers or small sores. The ulcers generate mucous and pus, causing abdominal pain plus the feeling to empty the bowel frequently. It develops as a result of various factors that are not appropriately understood. Some of the causal factors for ulcerative colitis include genetics, microbiome, abnormal immune response, as well as the environmental factors. The interaction between bacterial or viral infection and the immune response of the body triggers ulcerative colitis. It comes at any age, although various people are identified or diagnosed at around the mid-30s of age. Both the women and the men are affected almost equally, but it has been reported that the older males are at risk than aged women. Among the two main inflammatory diseases, ulcerative colitis is one of them, and the other is the Crohn disease. The condition is life long and involves the development of profound social and emotional impact on the patients’ affected (Sandborn et al., 2017). The body is protected from infections by the proteins and cells making up the immune system.

The inflammation in ulcerative colitis persists for a long time after the immune system has probably finished its work. The body responds by sending the WBCs to the intestinal walls continuously, and chronic inflammation followed by ulcers is the next result. For 95% of the patients affected, the rectum will be involved, and the degree of proximal extension is variable. The inflammation is thus limited to the mucous membrane, and it also consists of the persistent involvement of severity of the variable and result in hemorrhage, edema, and ulceration occurring alongside the colon. The blood may be visible in the egested materials, for example, diarrhea. For 25% of the cases, it is confined around the rectum, and as for the other cases, it spreads contiguously and proximally. It is a uniformly continuous and a striking disease. As it becomes chronic condition, the colon gets more rigid like the foreshortened tube and appears like lead- pipes seen in barium enema. The paper aims to discuss the pathophysiology of ulcerative colitis.

Figure 1 visualization of ulcerative colitis with a colonoscope

Normal anatomy of the major body system effected (Criteria 3):

The part of the body affected is the large intestines for ulcerative colitis, and normally the walls are consistent with no ulcers. The intestinal walls are continuous, and regular activities of the body executed with no problems. Ulcerative colitis causes inflammation interfering with the epithelial tissue or mucosa of the large intestines, and thus with time, it persists to form sores or ulcers which generate pain and even due to the mucosal destruction it is associated with blood which is observed when the individual goes for long calls frequently. The large intestines will have perforations, and this is not according to the normal anatomy of the large intestine and does not favor its functioning effectively (Harbord et al., 2017). It can also be associated with recurrences or relapses, and thus, the potential extraintestinal manifestations follow. The large intestine entails four parts, like the ascending colon and cecum, descending colon, sigmoid colon, and transverse colon.

Normal physiology of the major body system effected (Criteria 4):

The large intestines does its physiologic activities, for example, the absorption of mineral salts and water to the body. Propelling the indigestible materials is also its function. In the colon, most of the water and nutrients have been absorbed by the small intestines. When the food substances and other fluids from food and have passed through the small intestines it reaches the large intestines an here the mucosa or epithelium of the large intestines is adapted to create a force through gradient potential that allows the water and mineral salts from the food substances to be absorbed to the body and reach the blood system to maintain the normal activities and also ensure that the body fluids and mineral salts required by the body are healthy. With ulcerative colitis, there are some changes in the normal functioning of the colon, for example, constipation, diarrhea, and a difference in the bowel habits as well as the consistency of the stool. In ascending colon, the other nutrients and water remaining in the indigestible material is absorbed and then solidified, forming stool and emptied to the rectum to be egested. Storage of the indigested materials occurs in the descending colon. The sigmoid colon is adapted to contract and thus increases pressure in the colon to propel stool move to the rectum, which holds the feces and await to be removed by defecation.

Mechanism of Pathophysiology (Criteria 5):

Due to the abnormal responses to the microbiome, genetics, and some environmental factors, the interaction between a bacteria with the immune system of the body at the colon leads to the attack and development of ulcerative colitis. Usually, it starts in the rectum and, therefore, can remain localized to the area, which is another condition altogether (ulcerative proctitis). It can also extend proximally spreading around the entire large intestines. The inflammation triggered by the immune response and the bacteria or virus interaction leads to an attack of the mucosa as well as the submucosa. Between the affected and unaffected tissue, there is a sharp border. When severe, the inflammation ends up reaching the muscularis. When it begins, it is associated with erythematous tissue, friable and finely regular, and involves the loss of the normal vascular pattern and is thus scattered within the hemorrhagic areas (Timmer, Patton, Chande, McDonald & MacDonald, 2016). The large mucosal ulcers are formed, and they produce copious exudate of purulence when the condition is exacerbating to extreme severity. This will result in islands of then almost normal or inflammatory hyperplastic mucosa that is the pseudopolyps projecting above the sections with ulcerated mucosa. The etiology of ulcerative colitis is unknown. The individuals with ulcerative colitis tend to experience abdominal pain that is consistent and cramps. In the histologic findings concerning the acute or chronic inflammation of the mucosal layer by the polymorphonuclear leukocytes as well as mononuclear cells, depletion of the goblet cells, mucosal grand distortion and crypt abscesses.

Prevention (Criteria 6):

The prevention of ulcerative colitis (ways to avoid the pathophysiology of the condition) is not easy, but some modifications in lifestyle help to reduce the risks of developing the condition. Some of the ways to help prevent involves the adoption of methods that facilitate the reduction or elimination of the symptoms, for example, avoid taking some foods like cabbage, broccoli, dairy products, spicy foods, and beans. Dietary fiber should be increased as it is significant to help reduce constipation emanating from ulcerative colitis.

Treatment (Criteria 7):

Treatment involves the use of drugs, for example, loperamide in acute ulcerative colitis and restricts diet by avoiding some categories of food, which may exacerbate the pain and constipation. 5-Aminosalicylic acid can also be used to reduce the symptoms as well as the corticosteroids. The choice of drugs depends on the severity of the diseases and the presenting symptoms. Biologic agents and antimetabolites are also medications preferred for ulcerative colitis. Surgery can be performed. Restrict the use of vegetables and raw fruits, which help reduce the chances of causing trauma to the large intestine mucosa and thus reduce the symptoms. In mild diarrhea, give loperamide 2 mg orally twice or four times in a day, in more intensive diarrhea, increase the oral dosage to 4mg when one wakes up, and 2mg after every bowel movement. The antidiarrheal drugs can be of significance when the case is severe, as it can precipitate toxic dilation (Wang et al., 2016). For those having inflammatory bowel diseases, advice to use vitamin D and calcium ate the required amounts.

Clinical Relevance (Criteria 8):

The clinical relevance of this study on pathophysiology is important to educate on management and the symptoms of ulcerative colitis so that when experienced, the patients seek medical attention before it proceeds to ulcers and cancer. Identification at the early stages is quite key to manage and treat if possible. The pathophysiology explains how the disease begins and its accelerating factors and possibly the symptoms and complications it results to. We need to be keen on our lives to help detect any abnormality.

Conclusion:

In conclusion, ulcerative colitis is a dangerous condition and can lead to colon cancer, as well. It leads to a feeling of passing stool frequently, and this makes individuals uncomfortable. Restrict the use of vegetables and raw fruits, which help reduce the chances of causing trauma to the large intestine mucosa and thus reduce the symptoms, are some of the measures to help manage the condition.

References

Harbord, M., Eliakim, R., Bettenworth, D., Karmiris, K., Katsanos, K., Kopylov, U., … & de Sousa, H. T. (2017). Third European evidence-based consensus on diagnosis and management of ulcerative colitis. Part 2: current management. Journal of Crohn’s and Colitis, 11(7), 769-784.

Sandborn, W. J., Su, C., Sands, B. E., D’Haens, G. R., Vermeire, S., Schreiber, S., … & Friedman, G. (2017). Tofacitinib as induction and maintenance therapy for ulcerative colitis. New England Journal of Medicine, 376(18), 1723-1736.

Timmer, A., Patton, P. H., Chande, N., McDonald, J. W., & MacDonald, J. K. (2016). Azathioprine and 6‐mercaptopurine for maintenance of remission in ulcerative colitis. Cochrane Database of Systematic Reviews, (5).

Wang, Y., Parker, C. E., Bhanji, T., Feagan, B. G., & MacDonald, J. K. (2016). Oral 5‐aminosalicylic acid for induction of remission in ulcerative colitis. Cochrane Database of Systematic Reviews, (4).