Ulcerative Colitis


                                                         Pathology of UC


       Gross appearance:

                                        Mild disease

  • – Mucosal erythema, edema, granularity with or without small erosions
  • – Inflammation starts in the distal rectum and spreads proximally in continuous fashion for variable distance
  • – There is a sharp demarcation between the involved region of the distal colon and proximal uninvolved colon


                            Moderate to severe disease

  • – Ulceration or erosion with adherent mucopus, granularity, friability and hemorrhage
  • – In long standing disease- loss of normal haustral fold and flat, featurless appearance
  • – Inflammatory ‘pseudotumor’ may be present





  • Crypt abscess
  • – Crypt abscess may also present in crohn’s disease and infectious colitis
  • Neutrophils within the crypt as well as in the crypt wall and the adjacent lamina propria
  • Lamina propria is also infiltrated with chronic inflammatory cells
  • Architectural distortion of crypt
  •                     Shortening (not reaching the muscularis mucosa)
  •                    • Loss of normal parallel distribution
  • Paneth cell metaplasia, with Paneth cells located distal to the hepatic flexures where they normally are absent
  • Other non-specific changes:
  •                     Neuronal hypertrophy
  •                     Fibromuscular hyperplasia of the muscularis mucosa
  • ** Many of these features of chronic mucosal damage may be seen in CD also but the inflammatory process in UC does not usually disrupt the muscularis mucosa. But in severe or fulminant disease, inflammation may extend into the submucosa or transmurally into the muscularis


       Categories of UC according to the site of involvement

  • Ulcerative proctitis: Limited to distal 10-20 cm
  • Left sided colitis: Disease limited to distal to splenic flexure
  • Extensive colitis: Colonic inflammation extending proximal to the splenic flexure
  • Pancolitis: Involvement of the entire colon or proximal to the hepatic flexure
  • Limited disease: Disease confined to the rectosigmoid area
  • Extensive disease: Extensive beyond rectosigmoid


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