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Ulcerative Colitis

Rachel Chasteen

Galen College of Nursing

BIO 1300- Anatomy and Physiology II

Dr. Cameron Halfacre

Sunday, September 5th, 2021

Description of Pathology:
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Ulcerative Colitis (UC) is a disease affecting the lining of the large intestine. Ulcers form

along the inflamed digestive tract. However, symptoms typically take time to develop. People

with this disease often experience debilitating symptoms that can lead to life-threatening

complications. Ulcerative Colitis is a chronic disease, and treatment usually helps to lessen the

symptoms affecting the individual. People typically go into remission after years of no

symptoms. Symptoms of this disease are abdominal and rectal pain, rectal bleeding, diarrhea

with blood and pus, an urgency to defecate, inability to defecate, fatigue, fever, and weight loss.

(Mayo Clinic, n.d.) Perforation of the bowel is a common complication of UC and can be life-

threatening.

The CDC estimates that 1.3% of adults nationally are affected by this disease (3 million).

The causes of the disease are unknown, but scientists believe it is related to genes and abnormal

immune system reactions. People with UC are at a higher risk of colon cancer. Diagnostic testing

to confirm UC includes blood and stool testing and endoscopy. Treatment includes reducing

inflammation of the large intestine and sometimes surgery to reduce ischemia to the bowel. It is

vital to keep a nutrient-rich diet. Potassium is critical in the diet while experiencing symptoms

due to the amount of potassium lost while experiencing diarrhea.

Normal anatomy of the major body system effected (Criteria 2):

The large intestine is a long continuous organ. It begins at the ileocecal valve, where

chyme passes through from the small intestine. It then moves through the caecum and right

ascending colon to the right colic flexure, making a left turn. The chyme moves through the

transverse colon to the left colic flexure, where it will turn downward. It will move from the
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descending colon and sigmoid colon to the rectum and exit through the anus. The colon itself has

a segmented-like appearance called haustra. The large intestine is 1.5 meters long and, like the

small intestine, with no villi on its mucosa.

Normal physiology of the major body system affected (Criteria 3):

It typically takes 8 hours or so after ingestion for a meal to pass through the small

intestine to the larger intestine. When the chyme reaches the caecum, it is considered feces. Most

of the nutrient absorption has happened by this point in the digestive process. Also, nearly all the

ingested water was absorbed through the small intestine at this point. Food residue in the colon

starts haustral contractions, which happen every thirty minutes for one minute at a time. This

also facilitates the absorption of water and electrolytes. Aldosterone is released, which lowers

potassium and raises sodium in a sodium/potassium pump. The pump moves the ions in the

opposite direction across the cells. Food residue moves back towards the ileocecal valve with

antiperistatical contractions. This allows more time for feces to move through the large intestinal

tract and absorb water and electrolytes.

The feces contain “bacteria, old epithelial cells from the intestinal mucosa, inorganic

waste, undigested food matter and fiber, as well as water, fats, and proteins.” (Nursing Times,

2019) 150 milliliters of feces are created for every 500 milliliters of food residue that enters the

caecum. Chyme lingers for up to 24 hours in the large intestine. The water is absorbed, giving

the feces the consistency it has. Mucus from goblet cells line the colon, bind chyme, and

lubricate the waste's passage to move through. The urge to defecate is created by feces moving

into the rectum area. The large intestine does not secrete digestive enzymes. Therefore, the large
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intestine relies on colonic bacteria to break down. Flatulence is made through carbohydrate

breakdown by bacteria. Methane, carbon dioxide, and hydrogen create gas.

Mechanism of Pathophysiology (Criteria 4):

There are five main components to anatomical and physiological changes in a patient

with Ulcerative Colitis: The epithelial barrier of the colon, the mucosal layer of the colon,

leukocyte recruitment, immune response, and the microflora of the colon. Luminal antigen intake

is increased due to defects of the epithelial barrier in colonic mucin and tight junctions. An

increased number of activated, mature dendric cells are found in the Amina propria of the

mucosa. Toll-like receptors (TLR) are also increased, specifically TLR2 and TLR4. Cytotoxic

responses against epithelial cells happen due to abnormal reactions with T-helper (Th) cell

response. “Other immune-related factors that play a role in the pathophysiology of ulcerative

colitis include tumor necrosis factor-alpha (TNF-alpha), interleukin 13, and natural killer T-cells.

Levels of IgM, IgA, and IgG are elevated in inflammatory bowel disease; however, a

disproportionate increase in IgG1 antibodies is found in patients diagnosed with ulcerative

colitis.” (NCBI, 2021)

Leukocytes are recruited to the mucosa from the release of chemoattractant CXCL8. On

the endothelium of mucosal blood vessels, there is an increase of mucosal addressin cellular

adhesion molecule 1. It promotes leukocyte adhesion and extravasation into mucosal tissue.

“Studies have shown that enteric microflora is important in the pathogenesis and severity of

inflammation and disease phenotype. Ulcerative colitis seems to also result, in part, from a

homeostatic imbalance between enteric microflora and the host's mucosal immunity. This results
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in an aberrant response to non-pathogenic bacteria.” (NCBI, 2021) The colon's mucosal layer is

infiltrated, with varying compositions and densities depending on the stage of the infection. The

infiltrates contain lymphocytes, plasma cells, and granulocytes. Goblet cell depletion,

ulcerations, and alterations in mucosal crypts also occur.

Prevention (Criteria 5):

Ulcerative Colitis cannot be prevented. However, risk factors for the disease include

family history, race and ethnicity, and age. People with family history will be more prone to

develop the disease. White, Hispanic, and Ashkenazi Jewish people are more likely to suffer

from UC. Symptoms usually occur before the age of 30, but it can occur at any age.

Treatment (Criteria 6):

Treatment begins with sulfasalazine and 5-aminosalicylates with a 50% success rate.

After that, Glucocorticoids are given after two weeks of failed remission. Thiopurines and

biological drugs (anti-TNF-alpha and anti-adhesion molecule inhibitors) can also be used. Fecal

transplant has shown success in creating healthy gut bacteria. Colonoscopies are recommended

regularly due to colon cancer being the biggest complication of UC. Other complications include

leaking from anastomosis, pelvic abscesses, enterocutaneous fistulas, incontinence, sexual

dysfunction, toxic megacolon, severe dehydration, osteoporosis, perforation of the colon, and

risk of blood clots.

Conclusion:

Ulcerative Colitis is a disease affecting the colon. It is painful and sometimes fatal due to

the symptoms and complications that come with the disease. Treatment usually involves slowing

down symptoms to achieve remission. Remission can be achieved and can last for several years.

Symptoms include abdominal and rectal pain, rectal bleeding, diarrhea with blood and pus, an

urgency to defecate, inability to defecate, fatigue, fever, and weight loss. Three million adults

nationally have UC. Diagnostic testing is required to confirm diagnosis. It is important to keep a

nutrient-rich diet while experiencing symptoms and while in remission to prevent aggravation of

the disease.
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References:

Lynch, W. D., & Hsu, R. (2021, June 18). Ulcerative Colitis - StatPearls - NCBI Bookshelf.

International Center for Biotechnology Information.

https://www.ncbi.nlm.nih.gov/books/NBK459282/

Mayo Clinic. (2021, February 23). Ulcerative colitis - Symptoms and causes.

https://www.mayoclinic.org/diseases-conditions/ulcerative-colitis/symptoms-causes/syc-

20353326

National Institute of Diabetes and Digestive and Kidney Diseases. (2021, September 5).

Ulcerative Colitis.

https://www.niddk.nih.gov/health-information/digestive-diseases/ulcerative-colitis

Nursing Times. (2020, August 25). Gastrointestinal tract 5: the anatomy and functions of the

large intestine.

https://www.nursingtimes.net/clinical-archive/gastroenterology/gastrointestinal-tract-5-

anatomy-functions-large-intestine-23-09-2019/