ULCERATIVE COLITIS

• Ulcerative colitis (UC) is an inflammatory bowel disease characterised by chronic mucosal inflammation of the rectum, colon, and caecum
• Dominant symptom in UC is diarrhoea often associated with blood and mucous. In addition nocturnal defaecation, abdominal pain ( usually lower quadrant or rectal), fever, malaise, and weight loss may also be reported
• Most cases begin indolently and gradually worsen over several weeks, but some cases exhibit an initial attack of fulminant disease
• Individuals with UC are predisposed to colorectal cancer and should thus undergo regular surveillance colonoscopy

The exact mechanism is unknown, but involves one of the components and interactions

• Genetic predisposition
• Altered, dysregulated immune response
• Altered response to gut micro organisms
• Enviornmental factors

Risk factors

• Age : peak incidence 15 -35 years
• Race or Ethnicity
• Family history

Intestinal symptoms

• Bloody diarrhoea with mucus
• Nocturnal defaecation
• Incontinence, faecal urgency
• Abdominal pain and cramps
• Tenesmus

Extraintestinal symptoms 

• Skin : Erythema nodosum, Pyoderma gangrenosum, multiple aphthae and pustules of the oral mucosa
• Skeletal : Polyarthritis, sacroilitis, monoarthritis, osteoarthritis, ankylosing spondylitis, sacroilitis
• Eyes : uveitis, Iridocyclitis
• Lung: Alveolitis, Lung fibrosis
• Liver : primary sclerosing cholangitis , fatty liver
• Blood : Thromboembolic complications, Auto immune haemolytic anaemia

The disease is characterised as active colitis or flare (active disease) remission (quiescent phase) or chronic continuous disease (partially active disease)

• ↑ ESR, ↑ CRP, Hb
• Anaemia, Leukocytosis , hypoalbuminemia
• ↑ Perinuclear ANCA (pANCA)
• Stool analysis
• Colonoscopy- Proctosigmoiditis, Left-sided colitis, Extensive colitis
• Plain radiography - Loss of colonic haustra (lead pipe appearance) in severe cases 
• Barium enema radiography- to detect very early changes
• CT: to detect of bowel wall thickening
• MRI: in assessing disease severity and extent of bowel wall involvement
• Ultrasound: can detect bowel wall thickening

• Rehydration
• Supplementation of nutritional deficiencies
• Surgical intervention: Proctocolectomy with an ileal pouch-anal anastomosis (IPAA or J pouch)

Internal medicines

• Tiktaka kashaya
• Pachanamruta kashaya
• Vilwadi gutika
• Musta ksheera paka (Aja ksheera)
• Dadimashtaka choorna
• Pushyanuga choorna
• Sudarshana choorna
• Ashtakshari gutika