Fast Five Quiz: Ulcerative Colitis Signs and Symptoms

B.S. Anand, MD


April 29, 2022

UC is associated with various extracolonic manifestations, including uveitis, pyoderma gangrenosum, pleuritis, erythema nodosum, ankylosing spondylitis, and spondyloarthropathies.

PSC is the second most common extracolonic manifestation of UC and is a potentially serious condition. It often results in cholestatic jaundice and liver failure that requires liver transplantation. In patients with UC, 5% have cholestatic liver disease, and 40% of those have PSC. One hypothesis (by Marchesa et al.) about the etiology of PSC in patients with UC involves the release of proinflammatory agents in the colon and their absorption into the enterohepatic circulation, which are then concentrated in the biliary system, leading to bile duct damage.

In some cases, UC has a fulminant course marked by severe diarrhea and cramps, fever, leukocytosis, and abdominal distention. An estimated 15% of patients present with an attack severe enough to require hospitalization and steroid therapy, per Kedia et al. Fulminant disease occurs more often in children than in adults, who may also present with systemic complaints, such as fatigue, arthritis, failure to thrive, and delayed puberty.

Immunobullous disease of the skin has been associated with UC. One hypothesis regarding this association is the concept of epitope spread. Colonic inflammation leads to mucosal damage, which exposes otherwise hidden antigens. Antibodies to these antigens are then formed, which most likely are cell adhesion molecules, that cross-react with similar antigens in other tissues.

IBS is a functional gastrointestinal disorder characterized by abdominal pain and altered bowel habit in the absence of a specific and unique organic pathology, although microscopic inflammation has been documented in some patients. Because symptoms of abdominal pain and frequent diarrhea are like that of UC, a thorough patient history and making sure that sufficient diagnostic criteria have been met to warrant a diagnosis of IBS are essential.

Learn more about the clinical presentation of UC.


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