Ulcerative colitis history and symptoms

Patients with ulcerative colitis present with a history of bloody diarrhea mixed with mucus, of gradual onset. Some patients may present with a sudden attack of diarrhea, fever and abdominal pain. The extra intestinal symptoms may include joint swelling and pain, inflammation of the eye and skin involvement.^[1][2]

Ulcerative colitis patients usually give a history of bloody diarrhea accompanied with mucus. They also may complain of abdominal pain and tenesmus in some cases.^[2]

The clinical presentation^[1] of ulcerative colitis depends on the extent of the disease process. Patients usually present with

• Diarrhea mixed with blood and mucus, of gradual onset.
• Signs of weight loss
• Rectal urgency
• Tenesmus
• Blood is often noticed on underwear
• Different degrees of abdominal pain, from mild discomfort to severely painful cramps.

Ulcerative colitis is a systemic disease that affects many parts of the body. Sometimes the extra-intestinal manifestations of the disease are the initial signs, such as painful, arthritic knees in a teenager. It is, however, unlikely that the disease will be correctly diagnosed until the onset of the intestinal manifestations.

Ulcerative colitis is normally continuous from the rectum up the colon. The disease is classified by the extent of involvement, depending on how far up the colon the disease extends:

• Distal colitis, potentially treatable with enemas:^[3]
  • Proctitis: Involvement limited to the rectum.
  • Proctosigmoiditis: Involvement of the rectosigmoid colon, the portion of the colon adjacent to the rectum.
  • Left-sided colitis: Involvement of the descending colon, which runs along the patient’s left side, up to the splenic flexure and the beginning of the transverse colon.
• Extensive colitis, inflammation extending beyond the reach of enemas:
  • Pancolitis: Involvement of the entire colon, extending from the rectum to the cecum, beyond which the small intestine begins.

In addition to the extent of involvement, UC patients may also be characterized by the severity of their disease.^[3]

• Mild disease correlates with fewer than four stools daily, with or without blood, no systemic signs of toxicity, and a normal erythrocyte sedimentation rate (ESR). There may be mild abdominal pain or cramping. Patients may believe they are constipated when in fact they are experiencing tenesmus, which is a constant feeling of the need to empty the bowel accompanied by involuntary straining efforts, pain, and cramping with little or no fecal output. Rectal pain is uncommon.

• Moderate disease correlates with more than four stools daily, but with minimal signs of toxicity. Patients may display anemia (not requiring transfusions), moderate abdominal pain, and low grade fever, 38 to 39 °C (99.5 to 102.2 °F).

• Severe disease, correlates with more than six bloody stools a day, and evidence of toxicity as demonstrated by fever, tachycardia, anemia or an elevated ESR.

• Fulminant disease correlates with more than ten bowel movements daily, continuous bleeding, toxicity, abdominal tenderness and distension, blood transfusion requirement and colonic dilation (expansion). Patients in this category may have inflammation extending beyond just the mucosal layer, causing impaired colonic motility and leading to toxic megacolon. If the serous membrane is involved, colonic perforation may ensue. Unless treated, fulminant disease will soon lead to death.

The extra intestinal symptoms of ulcerative colitis include:^[4][5][6]

• Joint swelling
• Joint pain
• Inflammation of the eye
• Skin involvement
• Fatty liver
• Thromboembolism
• Parenchymal lung disease

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