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  • Surgery and Ulcerative Colitis

    Posted on June 18th, 2012 Patricia No comments

    Ulcerative colitis causes inflammation which leads to ulceration and destruction of the lining of the colon and rectum. The disease always involves the rectum, the very end of the gastrointestinal (GI) tract. When it is confined to the rectum, it is referred to as ulcerative proctitis. In other cases the disease may extend further into the large intestine, or colon. In these cases it is referred to as pancolitis.

    The colon is a hollow organ four to six feet long and about the thickness of your forearm. It rises from the rectum and extends up the left side of the abdomen, crosses under the rib cage and then down the right side of the abdomen where it joins the ileum, the end of the small intestine, or small bowel.

    The appendix is located at the end of the colon near where it joins the ileum, and sometimes the pain associated with Crohn’s disease in the ileum may be misdiagnosed as appendicitis. The inflammation of ulcerative colitis can affect any length of the colon, but it always starts in the rectum and is continuous, without any normal sections, for the length of colon involved. It never extends beyond the end of the colon into the upper gastrointestinal tract or small intestine.

    The inflammation of ulcerative colitis involves only the first layer of tissue on the inside of the colon, in contrast to Crohn’s disease, in which the chronic inflammation can affect all of the layers of intestinal tissue. The mucosa is a layer of folded intestinal tissue or membrane, almost like a ruffle of fabric, that is continuous throughout the intestines.

    The mucosa of the colon absorbs fluids secreted by the small intestine during digestion. This preserves fluids and electrolytes within the body and solidifies stool. The colonic mucosa also secretes a clear, viscous fluid called mucus that protects the large intestine.

    When the mucosa becomes inflamed, the capillaries dilate. Red blood cells weep out of the capillaries into the surrounding tissue along with white blood cells, plasma cells, and immune system cells such as lymphocytes and macrophages.

    As the inflammation progresses, the mucosal folds flatten out, dead cells and other debris get trapped and begin to decay, forming microscopic abscesses. The mucosa eventually splits or ulcerates. The ulcers are open wounds which release blood, pus and mucous into the intestine.

    When ulcerative colitis goes into remission, particularly in milder cases, the lining of the colon can begin to heal, and the layer of mucosa can regenerate.

    In extreme cases the mucosa all but disappears throughout the colon, and the colon itself thins, shortens and begins to resemble a smooth pipe.

    In its most severe form ulcerative colitis can present with a severe degree of inflammation and the colon begins to dilate. Patients are quite ill when this occurs and suffer from severe pain, fever and other metabolic abnormalities. This is referred to as toxic megacolon and with it comes a high risk of perforation of the colon. Often toxic megacolon requires emergency surgical removal of the colon, called a colectomy.

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