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Ulcerative Colitis Associations

Ulcer-volcano with Colon
Picmonic
Ulcerative colitis and Crohn’s disease are inflammatory bowel diseases characterized by chronic inflammation of a portion of the GI tract resulting from inappropriate mucosal immune activation. Ulcerative colitis is characterized by severe ulcerating inflammation of the mucosal and submucosal layers that is limited to the colon and rectum. Prolonged inflammation can lead to damage of the muscularis propria of the colon and perturb neuromuscular function causing colonic dilatation and toxic megacolon. Additionally, one of the most feared long-term complications of ulcerative colitis is the development of colorectal carcinoma. Risk of colorectal carcinoma sharply increased 8-10 years after initiation of disease and patients should have close surveillance after this time for evidence of neoplasia. There are also several extraintestinal manifestations of ulcerative colitis including anterior uveitis, pyoderma gangrenosum, and primary sclerosing cholangitis. 
7 KEY FACTS
ASSOCIATIONS
Toxic Megacolon
Mega-colon with Toxic-green-glow

Prolonged inflammation can lead to damage of the muscularis propria of the colon and perturb neuromuscular function causing colonic dilatation and toxic megacolon.

Colorectal Carcinoma
Colon-hat wearing Car-gnome

One of the most feared long-term complications of ulcerative colitis is the development of colorectal carcinoma. Risk of colorectal carcinoma sharply increased 8-10 years after initiation of disease. Therefore, patients typically have close surveillance approximately 8 years after diagnosis.

Anterior Uveitis
Ant wearing UV-sunglasses

Ocular complications can occur in some patients with ulcerative colitis including anterior uveitis. The uvea of the eye refers to the vascular middle layer including the iris, ciliary body, and the choroid. Anterior uveitis typically refers to inflammation of the iris and ciliary body.

Pyoderma Gangrenosum
Pie Gang-of-green

Pyoderma gangrenosum is characterized by necrotic tissue that causes deep ulcers, typically found on the legs. This skin manifestation is commonly associated with ulcerative colitis.

Ankylosing Spondylitis
Anchor Spine

One extra-intestinal manifestation of ulcerative colitis is the possibility of developing ankylosing spondylitis.  Roughly 4-10% of patients with ulcerative colitis can develop ankylosing spondylitis, which is a chronic inflammatory disease involving the axial skeleton

Primary Sclerosing Cholangitis
(1) Wand Skull-roses Cola-angel

Primary sclerosing cholangitis is characterized by progressive inflammation and scarring of the bile ducts in the liver leading to chronic liver disease. More than 80% of individuals with primary sclerosing cholangitis also have ulcerative colitis. Diagnosis is made by imaging the bile ducts via ERCP which demonstrates a beading pattern caused by strictures and dilations of the bile ducts.

P-ANCA
PANCAkes

The p-ANCA autoantibody is associated with most cases of ulcerative colitis, and hence reflects an immune response associated with the disease process. This is not specific enough of an antibody, however, to be used as a sole diagnostic measure of ulcerative colitis.

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