ULCERATIVE COLITIS

Ulcerative Colitis

1. Definition: Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD) characterized by chronic inflammation and ulcers in the innermost lining of the large intestine (colon and rectum).

2. Types:

   1. Ulcerative proctitis: Involves only the rectum.
   2. Proctosigmoiditis: Involves the rectum and sigmoid colon.
   3. Left-sided colitis: Involves the splenic flexure and descending colon.
   4. Pancolitis: Involves the entire colon.
   5. Backwash ileitis: Involves the terminal ileum.

3. Aetiology and Risk Factors:

   1. Genetic factors: Family history of IBD.
   2. Environmental factors: Smoking, stress, age.
   3. Abnormal immune response: Misdirected immune response against intestinal bacteria.
   4. Microbial factors: Alterations in the gut microbiome.

4. Pathogenesis:

   1. Inflammation: Chronic inflammation of the intestinal mucosa.
   2. Ulceration: Development of ulcers in the intestinal mucosa.
   3. Mucosal injury: Repeated cycles of inflammation and ulceration lead to mucosal injury.
   4. Compensatory mechanisms: Mucosal repair and regeneration.

5. Pathology:

   1. Inflammation: Neutrophil infiltration and crypt abscesses.
   2. Ulceration: Presence of ulcers in the intestinal mucosa.
   3. Mucosal damage: Loss of mucosal architecture and glandular structure.
   4. Crypt abscesses: Presence of neutrophils in the crypts.

6. Clinical Features:

   1. Diarrhea: Frequent and urgent bowel movements.
   2. Abdominal pain: Cramping and tenderness in the abdomen.
   3. Weight loss: Loss of appetite and weight.
   4. Rectal bleeding: Passage of blood and mucus through the rectum.
   5. Tenesmus: Feeling of incomplete evacuation of the bowel.

7. Extraintestinal Manifestations:

   1. Arthritis: Joint pain and swelling.
   2. Skin lesions: Erythema nodosum and pyoderma gangrenosum.
   3. Eye problems: Uveitis and conjunctivitis.
   4. Liver disease: Primary sclerosing cholangitis.
   5. Osteoporosis: Loss of bone density.

8. Complications:

   1. Toxic megacolon: Life-threatening condition characterized by bowel dilation and perforation.
   2. Colorectal cancer: Increased risk of colorectal cancer.
   3. Stricture: Narrowing of the intestine.
   4. Fistula: Abnormal connection between the intestine and another organ or the skin.

9. Diagnostic Role of Colonoscopy and Biopsy:

   1. Colonoscopy: Visual examination of the colon and rectum.
   2. Biopsy: Collection of tissue samples for histological examination.

10. Homoeopathic Therapeutics:

    1. Calcarea carbonica: For chronic inflammation and ulcers.
    2. Hydrastis canadensis: For gut inflammation and ulcers.
    3. Silica: For mucosal injury and repair.
    4. Phosphorus: For rectal bleeding and tenesmus.
    5. Arsenicum album: For chronic diarrhea and weight loss.