colitis

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Inflammation of the large intestine, with pain, diarrhoea, and weight loss; there may be ulceration of the large intestine (ulcerative colitis). See also Crohn's disease; gastro-intestinal tract; irritable bowel syndrome.

An inflammation of the mucous membrane that lines the colon. Colitis is characterized by pain in the abdomen, with alternating episodes of constipation and diarrhea.

Pl. colitides; inflammation of the colon. There are many types of colitis, each having different etiologies. The differential diagnosis involves the clinical history, fecal examinations, proctoscopy, radiological studies such as barium enemas, and sometimes biopsy.

• antibiotic-associated c. — colitis associated with antimicrobial therapy occurs in humans and animals. It can range from mild nonspecific colitis and diarrhea to severe fulminant pseudomembranous colitis (see below) with profuse watery diarrhea. The inflammation may be caused by a toxin produced by Clostridium difficile, a microorganism that is not normally present in the resident bowel flora. Presumably, the disruption of the normal flora allows the growth of C. difficile. There is developing evidence that, in foals and adult horses, C. difficile can be associated with diarrheal disease that can vary from mild to self-limiting to an acute and fatal enterocolitis. Evidence for this association is the biological plausibility, some evidence that this syndrome can be reproduced experimentally, and the ability to demonstrate the organism or its toxin in the feces of horses with the enterocolitis in comparison with the low prevalence and absence of toxin in the feces of non-diarrheic horses. This syndrome commonly occurs in horses following antimicrobial therapy and/or hospitalization. It is possible that enterotoxin from intestinal C. perfringens may also contribute in horses and the syndrome has been called equine clostridiosis.
• ciliate c. — colitis in primates caused by Troglodytella spp. and characterized by diarrhea.
• c. cystica profunda — dilated, grossly visible colonic glands protrude through the muscularis mucosae into the submucosa; no specific cause attributed; an incidental necropsy finding, especially in pigs.
• eosinophilic ulcerative c. — occurs in humans and dogs, either as a primary disease or as part of an eosinophilic gastroenteritis. Characterized histologically by eosinophilic infiltration of the lamina propria and submucosa. May be caused by hypersensitivity reactions, parasites or foreign body reactions.
• granulomatous c. — see histiocytic ulcerative colitis (below).
• histiocytic ulcerative c. — a chronic, debilitating inflammation of the colon occurring predominantly in young Boxer dogs. Affected dogs have a chronic hemorrhagic diarrhea with tenesmus, and occasionally vomiting, inappetence and weight loss. Colonic mucosa is thickened, friable and ulcerated. Macrophages containing PAS-positive granules are found in the mucosa and submucosa. The cause of this disease is unknown. It is similar, but not identical to, ulcerative colitis, granulomatous colitis and Whipple's disease of humans.
• idiopathic c. — a disease similar to histiocytic ulcerative colitis (above), occurring predominantly in dogs other than Boxers and lacking the PAS-positive granules in histiocytes.
• mucous c. — see irritable colon syndrome.
• plasmacytic–lymphocytic c. — mucosal infiltration by plasmacytes and lymphocytes associated with sign of colitis in dogs. Dietary hypersensitivity is considered an important cause.
• pseudomembranous c. — a severe acute inflammation of the bowel mucosa, with the formation of pseudomembranous plaques. It is most commonly associated with antimicrobial therapy (see antibiotic-associated colitis (above)). Called also pseudomembranous enterocolitis.
• psychologically induced c. — see irritable colon syndrome.
• uremic c. — an outstanding lesion in cattle dying of uremia.
• c.-X — a peracute colitis of horses, sometimes occurring as outbreaks, characterized by a short course of about 24 hours, profuse diarrhea, sometimes with colic and dysentery and profound dehydration. The cause is unknown and the outcome invariably fatal.

An inflammatory condition of the large intestine. Most of the diseases of this group are of unknown origin.

• Diseases and Infestations - colitis: any inflammation of colon, causing diarrhea and lower abdominal pain

Colitis
Classification and external resources
A micrograph demonstrating cryptitis, a microscopic correlate of colitis. H&E stain.
ICD-10	K50 - K52
ICD-9	556.9
OMIM	191390
DiseasesDB	31340
MedlinePlus	001125
eMedicine	ped/435
MeSH	C06.405.205.265

In medicine, colitis (pl. colitides) refers to an inflammation of the colon and is often used to describe an inflammation of the large intestine (colon, caecum and rectum).

Colitides may be acute and self-limited or chronic, i.e. persistent, and broadly fit into the category of digestive diseases.

In a medical context, the label colitis (without qualification) is used if:

• The aetiology of the inflammation in the colon is undetermined; for example, colitis may be applied to Crohn's disease at a time when the diagnosis has not declared itself, or
• The context is clear; for example, an individual with ulcerative colitis is talking about their disease with a physician that knows the diagnosis.

Contents 1 Signs and symptoms 2 Diagnosis 3 Types 3.1 Autoimmune 3.2 Idiopathic 3.3 Iatrogenic 3.4 Vascular disease 3.5 Infectious 3.6 Unclassifiable colitides 3.7 Severity of colitides 4 Treatment 5 See also 6 Notes 7 External links

Signs and symptoms

The signs and symptoms of colitides are quite variable and dependent on the etiology (or cause) of the given colitis and factors that modify its course and severity.

Symptoms of colitis may include: abdominal pain, loss of appetite, fatigue, diarrhea, cramping, urgency and bloating.

Signs may include: abdominal tenderness, weight loss, changes in bowel habits (increased frequency), fever, bleeding (overt or occult)/bloody stools, diarrhea and distension.

Signs seen on colonoscopy include: colonic mucosal erythema (redness of the inner surface of the colon), ulcers, bleeding.

Diagnosis

Symptoms suggestive of colitis are worked-up by obtaining the medical history, a physical examination and laboratory tests (CBC, electrolytes, stool culture and sensitivity, stool ova and parasites et cetera). Additional tests may include medical imaging (e.g. abdominal computed tomography, abdominal X-rays) and an examination with a camera inserted into the rectum (sigmoidoscopy, colonoscopy).

Types

There are many types of colitis. They are usually classified by the etiology.

Types of colitis include:

Micrograph showing intestinal crypt branching, a histopathological finding of chronic colitis. H&E stain.

Micrograph of collagenous colitis. H&E stain.

Micrograph of a colonic pseudomembrane, as may be seen in in Clostridium difficile colitis, a type of infectious colitis.

Autoimmune

• Inflammatory bowel disease (IBD) - a group of chronic colitides.
  Main article: Inflammatory bowel disease
  • Ulcerative colitis - a chronic colitis that affects the large intestine.
    Main article: Ulcerative colitis
  • Crohn's disease - a type of IBD often leads to a colitis.
    Main article: Crohn's disease

Idiopathic

• Microscopic colitis - a colitis is diagnosed by microscopic examination of colonic tissue; macroscopically it is normal appearing.
  Main article: Microscopic colitis
  • Lymphocytic colitis.
    Main article: Lymphocytic colitis
  • Collagenous colitis.
    Main article: Collagenous colitis

Iatrogenic

• Diversion colitis.
  Main article: Diversion colitis
• Chemical colitis.
  Main article: Chemical colitis

Vascular disease

• Ischemic colitis.
  Main article: Ischemic colitis

Infectious

• Infectious colitis.

A well-known subtype of infectious colitis is Clostridium difficile colitis,^[1] which is informally abbreviated as "c diff colitis". It classically forms pseudomembranes and is often referred to as pseudomembranous colitis, which is its (non-specific) histomorphologic description.

Enterohemorrhagic colitis may be caused by Shiga toxin in Shigella dysenteriae or Shigatoxigenic group of Escherichia coli (STEC), which includes serotype O157:H7 and other enterohemorrhagic E. coli.^[2]

Parasitic infections, like those caused by Entamoeba histolytica, can also cause colitis.

Unclassifiable colitides

Indeterminate colitis is a term used for a colitis that has features of both Crohn's disease and ulcerative colitis.^[3] Indeterminate colitis' behaviour is usually closer to ulcerative colitis than Crohn's disease.^[4]

Atypical colitis is a phrase that is occasionally used by physicians for a colitis that does not conform to criteria for accepted types of colitis. It is not an accepted diagnosis per se and, as such, a colitis that cannot be definitively classified.

Severity of colitides

Fulminant colitis is any colitis that becomes worse rapidly. In addition to the diarrhea, fever, and anemia seen in colitis, the patient has severe abdominal pain and presents a clinical picture similar to that of septicemia, where shock is present. About half of human patients require surgery. In horses, the fulminant colitis known as colitis X usually results in death within 24 hours.

Irritable bowel syndrome, a separate disease, has been called spastic colitis. This name may lead to confusion, since colitis is not always a feature of irritable bowel syndrome. Since the etiology of IBS is currently unknown and possibly multifactorial, there may be some overlap in symptoms between IBS and the various forms of colitis.

Treatment

How a given colitis is treated is dependent on its etiology, e.g. infectious colitis are usually treated with antimicrobial agents (e.g. antibiotics); autoimmune mediated colitis is treated with immune modulators/immune suppressants. Severe colitis can be life-threatening and may require surgery.

See also

• Gastroenterology

Interleukin-37

Notes

1. ^ "Clostridium Difficile Colitis - Overview". WebMD, LLC. http://www.webmd.com/digestive-disorders/tc/clostridium-difficile-colitis-overview. Retrieved 2006-09-15. 
2. ^ Beutin L (2006). "Emerging enterohaemorrhagic Escherichia coli, causes and effects of the rise of a human pathogen". J Vet Med B Infect Dis Vet Public Health 53 (7): 299–305. doi:10.1111/j.1439-0450.2006.00968.x. PMID 16930272. 
3. ^ Romano, C.; Famiani, A.; Gallizzi, R.; Comito, D.; Ferrau', V.; Rossi, P. (Dec 2008). "Indeterminate colitis: a distinctive clinical pattern of inflammatory bowel disease in children.". Pediatrics 122 (6): e1278–81. doi:10.1542/peds.2008-2306. PMID 19047226. 
4. ^ Melton, GB.; Kiran, RP.; Fazio, VW.; He, J.; Shen, B.; Goldblum, JR.; Achkar, JP.; Lavery, IC. et al. (Jul 2009). "Do preoperative factors predict subsequent diagnosis of Crohn's disease after ileal pouch-anal anastomosis for ulcerative or indeterminate colitis?". Colorectal Dis 12 (10): 1026–32. doi:10.1111/j.1463-1318.2009.02014.x. PMID 19624520. 

External links

Wikimedia Commons has media related to: Colitis

• Colitis at GPnotebook

v d e Digestive system · Digestive disease · Gastroenterology (primarily K20–K93, 530–579) Upper GI tract Esophagus Esophagitis (Candidal, Herpetiform) · rupture (Boerhaave syndrome, Mallory-Weiss syndrome) · UES (Zenker's diverticulum) · LES (Barrett's esophagus) · Esophageal motility disorder (Nutcracker esophagus, Achalasia, Diffuse esophageal spasm, Gastroesophageal reflux disease (GERD)) · Laryngopharyngeal reflux (LPR) · Esophageal stricture · Megaesophagus Stomach Gastritis (Atrophic, Ménétrier's disease, Gastroenteritis) · Peptic (gastric) ulcer (Cushing ulcer, Dieulafoy's lesion) · Dyspepsia · Pyloric stenosis · Achlorhydria · Gastroparesis · Gastroptosis · Portal hypertensive gastropathy · Gastric antral vascular ectasia · Gastric dumping syndrome · Gastric volvulus Lower GI tract: Intestinal/ enteropathy Small intestine/ (duodenum/jejunum/ileum) Enteritis (Duodenitis, Jejunitis, Ileitis) — Peptic (duodenal) ulcer (Curling's ulcer) — Malabsorption: Coeliac · Tropical sprue · Blind loop syndrome · small bowel bacterial overgrowth syndrome  · Whipple's · Short bowel syndrome · Steatorrhea · Milroy disease · bile acid malabsorption Large intestine (appendix/colon) Appendicitis · Colitis (Pseudomembranous, Ulcerative, Ischemic, Microscopic, Collagenous, Lymphocytic) · Functional colonic disease (IBS, Intestinal pseudoobstruction/Ogilvie syndrome) — Megacolon/Toxic megacolon · Diverticulitis/Diverticulosis Large and/or small Enterocolitis (Necrotizing) · IBD (Crohn's disease) — vascular: Abdominal angina · Mesenteric ischemia · Angiodysplasia — Bowel obstruction: Ileus · Intussusception · Volvulus · Fecal impaction — Constipation · Diarrhea (Infectious) · Intestinal adhesions Rectum Proctitis (Radiation proctitis) · Proctalgia fugax · Rectal prolapse · Anismus Anal canal Anal fissure/Anal fistula · Anal abscess  · Anal dysplasia  · Pruritus ani GI bleeding/BIS Upper (Hematemesis, Melena) · Lower (Hematochezia) Accessory Liver Hepatitis (Viral hepatitis, Autoimmune hepatitis, Alcoholic hepatitis) · Cirrhosis (PBC) · Fatty liver (NASH) · vascular (Budd-Chiari syndrome, Hepatic veno-occlusive disease, Portal hypertension, Nutmeg liver) · Alcoholic liver disease · Liver failure (Hepatic encephalopathy, Acute liver failure) · Liver abscess (Pyogenic, Amoebic) · Hepatorenal syndrome · Peliosis hepatis Gallbladder Cholecystitis · Gallstones/Cholecystolithiasis · Cholesterolosis · Rokitansky-Aschoff sinuses · Postcholecystectomy syndrome · Porcelain gallbladder Bile duct/ other biliary tree Cholangitis (PSC, Secondary sclerosing cholangitis, Ascending) · Cholestasis/Mirizzi's syndrome · Biliary fistula · Haemobilia · Gallstones/Cholelithiasis common bile duct (Choledocholithiasis, Biliary dyskinesia) · Sphincter of Oddi dysfunction Pancreatic Pancreatitis (Acute, Chronic, Hereditary, Pancreatic abscess) · Pancreatic pseudocyst · Exocrine pancreatic insufficiency · Pancreatic fistula Abdominopelvic Hernia Diaphragmatic (Congenital) · Hiatus Inguinal (Indirect, Direct) · Umbilical · Femoral · Obturator · Spigelian lumbar (Petit's, Grynfeltt-Lesshaft) undefined location (Incisional · Internal hernia) Peritoneal Peritonitis (Spontaneous bacterial peritonitis) · Hemoperitoneum · Pneumoperitoneum M: DIG anat(t, g, p)/phys/devp/enzy noco/cong/tumr, sysi/epon proc, drug(A2A/2B/3/4/5/6/7/14/16), blte

v d e Inflammation Acute Plasma derived mediators Bradykinin · complement (C3, C5a, MAC) · coagulation (Factor XII, Plasmin, Thrombin) Cell derived mediators preformed: Lysosome granules · vasoactive amines (Histamine, Serotonin) synthesized on demand: cytokines (IFN-γ, IL-8, TNF-α, IL-1) · eicosanoids (Leukotriene B4, Prostaglandins) · Nitric oxide · Kinins Chronic Macrophage · Epithelioid cell · Giant cell · Granuloma Processes Traditional: Rubor · Calor · Tumor · Dolor (pain) · Functio laesa Modern: Acute-phase reaction/Fever · Vasodilation · Increased vascular permeability · Exudate · Leukocyte extravasation · Chemotaxis Specific locations Nervous CNS (Encephalitis, Myelitis) · Meningitis (Arachnoiditis) · PNS (Neuritis) · eye (Dacryoadenitis, Scleritis, Keratitis, Choroiditis, Retinitis, Chorioretinitis, Blepharitis, Conjunctivitis, Iritis, Uveitis) · ear (Otitis, Labyrinthitis, Mastoiditis) Cardiovascular Carditis (Endocarditis, Myocarditis, Pericarditis) · Vasculitis (Arteritis, Phlebitis, Capillaritis) Respiratory upper (Sinusitis, Rhinitis, Pharyngitis, Laryngitis) · lower (Tracheitis, Bronchitis, Bronchiolitis, Pneumonitis, Pleuritis) · Mediastinitis Digestive mouth (Stomatitis, Gingivitis, Gingivostomatitis, Glossitis, Tonsillitis, Sialadenitis/Parotitis, Cheilitis, Pulpitis, Gnathitis) · tract (Esophagitis, Gastritis, Gastroenteritis, Enteritis, Colitis, Enterocolitis, Duodenitis, Ileitis, Caecitis, Appendicitis, Proctitis) · accessory (Hepatitis, Cholangitis, Cholecystitis, Pancreatitis) · Peritonitis Integumentary Dermatitis (Folliculitis) · Cellulitis · Hidradenitis Musculoskeletal Arthritis · Dermatomyositis · soft tissue (Myositis, Synovitis/Tenosynovitis, Bursitis, Enthesitis, Fasciitis, Capsulitis, Epicondylitis, Tendinitis, Panniculitis) Osteochondritis: Osteitis (Spondylitis, Periostitis) · Chondritis Urinary Nephritis (Glomerulonephritis, Pyelonephritis) · Ureteritis · Cystitis · Urethritis Reproductive female: Oophoritis · Salpingitis · Endometritis · Parametritis · Cervicitis · Vaginitis · Vulvitis · Mastitis male: Orchitis · Epididymitis · Prostatitis · Balanitis · Balanoposthitis pregnancy/newborn: Chorioamnionitis · Omphalitis Endocrine Insulitis · Hypophysitis · Thyroiditis · Parathyroiditis · Adrenalitis Lymphatic Lymphangitis · Lymphadenitis

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