Ulcerative Colitis is a signifier of chronic inflammatory intestine disease that effects the colon largely in the recto-sigmoid part. It is a signifier of inflammatory bowel disease, in which the colon becomes inflamed and develops bantam unfastened sores in the liner of colon ( Crohn ‘s & A ; Colitis foundation of America, 2013 ) .
This bantam unfastened sores or ulcers, produce Pus and mucous secretion. Ulcerative inflammatory bowel disease comes in stages with gradual decomposition of the enteric wall with abdominal hurting and spasms, rectal hemorrhage and diarrhoea incorporating blood, Pus and mucous secretion. But in some instances, toxic megacolon ( utmost distension of a section of colon ) and possible perforation in the peritoneal pit might happen due to a really terrible ague procedure ( Bontrager & A ; Lampignano, 2010 ) .
Ulcerative Colitis can impact people at any age but it frequently occurs in adolescents and immature grownups between the age of 15-30 old ages. Crohn ‘s & A ; Colitis foundation of America province that, Ulcerative Colitis is the consequence of an unnatural organic structure response to our organic structure ‘s immune system. The immune system that consists of a aggregation of cells and protein protects our organic structure from potentially harmful infective micro-organisms. However the immune system attacks our nutrient, bacteriums and other stuffs misidentifying it for harmful pathogens. When this happens, our organic structure will direct white blood cells into the liner of he intestines which will bring forth chronic redness and ulceration.
2.1 Anatomy of Colon
Figure 1: Colon or big bowels was divided into six part
The colon or big bowel is the last portion of digestive system. It is 1.5m ( 5ft ) long and 6.5cm ( 2.5 inch ) in diameter which covers the intraperitoneal pit. It map is to take H2O and salt from solid waste before the laxation procedure takes topographic point. Colon was different from little bowels as it does non take portion in the major function of soaking up of nutrients and food. Somehow, it does absorb H2O, Na and some fat soluble vitamin. Colon or big bowels consist of six subdivisions:
Cecum Intestinal pouch located at the junction of big and little bowels which is of import in cellulose digestion.
Ascending colon Lies vertically in the sidelong portion of abdominal pit.
Transverse colon A horizontal class from right to go forth and merely below the lien it takes right angle bend to organize falling colon.
Descending colon Lies vertically in the most sidelong left portion of abdominal pit. Consist of sigmoid colon and rectum at the distal part.
Sigmoid colon The S-shape curve lies between falling colon and rectum. Its length is about 40cm.
Rectum The terminal portion of big bowel that ends with anus. About 12cm in length.
2.1.1 Histology of Colon
Figure 2: Four different liners in the wall of colon
The wall of colon contains four different beds which is:
( a ) Mucosa layer The mucous membrane bed consist of epithelial tissue, connective tissue and smooth musculus. The epithelial tissue contains enteric secretory organ that composed of absorbent and goblet cells. The map of absorbent cell is to absorbs H2O while goblet cells secretes mucus that act as a lubricator The nodules were found in connective tissue and it will extends until submuscularis mucous membrane of submucosa.
( B ) Submucosa Compose of connective tissue and some sum of fat.
( degree Celsius ) Muscularis Contains two beds of smooth musculus that is internal round bed and external longitudinal bed. The external longitudinal musculus bed runs most of the length of colon. Muscularis bed enclosed by 3 conspicuous set executing teniae coli.
( vitamin D ) Serosa Part of splanchnic peritoneum that contains fat and connected to teniae coli.
The etiology of this cause is unknown ( Kowalczyk & A ; D. Mace, 2009, p. 119 ) . But it is thought that cistrons, environment and immune system might be the hazard factors of holding Ulcerative Colitis.
2.2.1 Familial Factor
Research workers have found that Ulcerative Colitis tends to run in households. The hazard of holding inflammatory intestine disease is between 5.2 per centum and 22.5 per centum for first grade relations ( Crohns & A ; Colitis foundation of America, 2013 ) . About 1 in 5 people that holding Ulcerative Colitis had close relations infected with the same disease ( Christian Nordqvist, 2009 ) . Furthermore, harmonizing to D. Basson ( 2009 ) , a household history observed in 1 in 6 relations associate with Ulcerative Colitis will developed higher hazard. In add-on, degrees of Ulcerative Colitis are higher in certain cultural groups and indistinguishable twins. This shows that Ulcerative inflammatory bowel disease somehow can be genetically inherited.
2.2.2 Environment Factor
How people live seems to play a function in the development of this disease. Air pollution, coffin nail smoke, hygiene and diet can be the part factor to Ulcerative Colitis. Diet affected a individual to a higher hazard particularly those typical European. These people diet is high in saccharide and fats, which may explicate why Asiatic people who tend to eat a diet low in saccharide and fats are less likely affected by this disease. Besides, high ingestion of unsaturated fat and vitamin B6 might besides increase the hazard of acquiring the disease ( Geerling et al. , 2000 ) .
2.2.3 Immune System
Some research workers think virus can trip Ulcerative Colitis ( Mayo Clinic Staff, 2012 ) . The immune system protects our organic structure from infections. But in Ulcerative Colitis, for some unknown ground, after the infection has gone the immune system continues to react which will later doing redness. This status is known as autoimmune response.
Ulcerative Colitis fundamentally starts from rectum and spreads proximally to sigmoid and subsequently involves a variable length of colon. Inflammation and ulcers largely affected merely the innermost liner of colon wall. The greater the affected country, the greater the symptoms will be.
The field visual aspect varies with the activity of the disease. Merely the mucous membrane will be seen with variable ulcers ( Fig. 3 ) . While, the visual aspect of fistulous withers, stricture and important inspissating othe wall will non be seen seldom ( K. Geboes, n.d. ) .
Figure 3: ( A ) A normal vacularised mucous membrane of colon ( B ) An redness on the mucous membrane wall
Ulcers of mucous membrane
An abcess will be visualized in the crypt cells after the redness takes topographic point at the mucous membrane and submucosa ( reticulum fibres beneath the mucosal epithelial tissue ) ( Fig 4 ) . This will do the cell to loss their blood supply and taking to epithelial mortification and mucosal ulceration ( Kowalczyk & A ; D. Mace, 2009 ) . The mucous membrane so will be replaced by hempen tissue which will look as aa‚¬A“cobblestonesaa‚¬A? . Inaddition, Johns Hopkins Medicine ( n.d. ) province that, the badness of the disease might be variable histologically, runing from minimum to florid ulceration and dysplasia. Carcinoma might happen. The lesion of Ulcerative Colitis was the crypt abcess, in which the epithelial tissue of the crypt cells breaks down and the lms fills with polymorphonuclear cells. The lamina propria is infiltrate with leucocytes. This will do the normal physique of crypt cell to damage and causes the marking shortens with narrowed colon ( Johns Hopkins Med. , n.d. ) .
Figure 4: Microscopic position of the mucous membrane, demoing diffuse active redness with crypt abscess and glandular architectural deformation
Following the healing of mucosal ulcers, the pseudopolyps will look typically little and multiple and can be found in sigmoid and falling colon but seldom found in rectum ( Fig. 5 ) .
Figure 5: Ulcerated haemorrhagic surface with knobby pseudopolyps