Ulcerative colitis (UC) is one of the 2 major types of inflammatory bowel disease ( IBD), along with Crohn disease. Unlike Crohn disease, which. Ulcerative colitis is an inflammatory bowel disease that not only predominantly affects the colon, but also has extraintestinal manifestations. Epidemiology. ABSTRAK. Latar belakang: panduan tatalaksana untuk kolitis ulseratif (KU) belum tersedia. Saat ini, mesalazine, kortikosteroid, dan imunomodulator.
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Typically ulcerative colitis manifests in young adults years of age and is more prevalent in males but the onset of disease after age of 50 is also common 1,3,5. A combination of environmental and genetic factors are thought to play a role in the pathogenesis, although the condition remains idiopathic.
Ulcerative colitis is less prevalent in smokers than in non-smokers. C-reactive protein levels are usually normal 6. Unlike Crohn disease which is characteristically a transmural disease, ulcerative colitis is usually limited to the mucosa and submucosa 5. Chronic disease is associated with a significantly elevated malignancy risk, of up to 0. One of the most commonly used scoring systems.
Total score ranges from 8. Newer endoscopic scoring system which includes assessment of vascular pattern, bleeding, and ulcers and excludes mucosal friability. The entire colon may be involved, in which case edema of the terminal ileum may also be present so-called backwash ileitis. In very severe cases, ulsedatif colon becomes atonic, with marked dilatation, worsened by bacterial overgrowth.
This leads to toxic megacolon which although uncommon has a poor prognosis. Non-specific findings, but may show evidence of mural thickening more commonwith thumbprinting also seen in more severe cases. Double contrast barium enema allows for exquisite detail of the colonic mucosa and also allows the bowel proximal to strictures to be assessed. It is however contraindicated if acute severe colitis is present due to the risk of perforation. Mucosal inflammation leads a granular appearance to the surface of the bowel.
As inflammation increases, the bowel wall and haustra thicken.
Mengenal Tanda-Tanda Dan Gejala Ulcerative Colitis
Mucosal ulcers are undermined button-shaped ulcers. When most of the mucosa has been lost, kplitis of mucosa remain giving it a pseudopolyp appearance. In chronic cases, the bowel becomes featureless with the loss of normal haustral markings, luminal narrowing and bowel shortening lead pipe sign.
Small islands of residual mucosa can grow into thin worm-like structures so-called filiform polyps.
Current treatment of ulcerative colitis
Colorectal carcinoma in the setting of ulcerative colitis is more frequently sessile and may appear to be a simple stricture. CT will reflect the same changes that are seen with a barium enema, with the additional advantage of being able to directly visualize the colonic wall, the terminal ileum and identify extra-colonic complications, such ulseatif perforation or abscess formation.
It is important to note however that CT is insensitive to early mucosal disease 2. Inflammatory pseudopolyps may be seen if large enough, in well distended bowel.
In areas of mucosal denudation, abnormal thinning of the bowel may also be evident 2.
A cross-section of the inflamed and thickened bowel has a target appearance due concentric rings of varying attenuation, also known as mural stratification 1,2. In chronic cases, fat submucosal deposition is seen particularly in the rectum fat halo sign. Also in this region, extramural deposition of fat, leads to thickening of the perirectal fat, and widening of the presacral space 1,2. Strictures are also common and are not all malignant. These are predominantly due to marked muscularis mucosa hypertrophy, which is also in part responsible for the lead pipe sign.
Ulcerative colitis | Radiology Reference Article |
Colorectal carcinoma is often sessile. Focal loss of mural stratification or excessive mural thickness 1. The current status of MRI in ulcerative colitis is that of a promising, non-invasive technique for imaging extent of more severe disease.
The most striking abnormalities in ulcerative colitis are wall thickening and increased enhancement. The median wall thickness in ulcerative colitis ranges from 4. In general, the more severe the inflammation, the thicker the colonic wall. Use of diffusion-weighted imaging in the assessment of ulcerative colitis has been encouraging. Total colectomy is curative of both the intestinal symptoms and of the potential risk of colorectal carcinoma. Medical therapy is able in some cases to control the colonic disease but does not remove the need to carefully and regularly screen for malignancy.
Due to close surveillance patients with ulcerative colitis have a normal or even slightly improved survival compared to normal population 3. This is clearly not the case if the disease is not diagnosed or treatment not available.
The most important differential diagnosis is Crohn disease see Crohn disease vs ulcerative colitis. Otherwise, the differential includes other causes of colitis:.
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