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Virtual Pediatric Hospital: Paediapaedia: Ulcerative Colitis (UC) Paediapaedia: Gastrointestinal Diseases

Ulcerative Colitis (UC)

Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed


Clinical Presentation:
Fifteen percent of patients with this disease present as children between the ages of 10-16. The most common clinical pattern in children is intermittent acute colitis with interval remissions that causes mucous diarrhea, colicky abdominal pain, melena and tenesmus. Liver disease and arthritis may be seen as extracolonic manifestations. Systemic symptoms include anemia, anorexia, nutritional deficiency, and electrolyte imbalance. Colon cancer develops more frequently in cases that present early.

Etiology/Pathophysiology:
Etiology is ill defined. First a nonspecific inflammation of the mucosa and submucosa is seen followed by widespread superficial ulceration, then muscular and serosal involvement leading to a rigid short colon is seen. Usually involves the total colon, beginning in the rectum and proceeding in a retrograde fashion. Has symmetrical and contiguous colon involvement without skip lesions as are seen in Crohn's Disease.

Pathology:
Not applicable

Imaging Findings:
Abdominal plain film may show colonic edema ("thumb printing") or narrowing with loss of haustrations.

On double contrast barium enema acutely finely spiculated mucosal ulcers with variable edema and normal haustra are seen. With advancing disease, more prominent ulcers are seen that form a serrated mucosal contour. Eventually, the ulcers coalesce into collar button abscesses as well as into pseudopolyps. The end stage is a loss of haustral markings, colonic shortening and narrowing of colon. Ten percent of cases have backwash ileitis with involvement of the terminal ileum.

DDX:

References:
See References Chapter.

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