Ulcerative Colitis, Chronic

Incidence in USA and Northern countries of 35-100:100,000; incidence of 11:100,000/y with 2- to 4-fold increased frequency in Jewish populations.

Mortality highest in early years of disease, or with prolonged disease due to risk of colon cancer; two peaks for age of onset: 15–30 y and 60–80 y.

Male:female ratio is 1:1; smokers:nonsmokers, 0.4:1; former smokers:nonsmokers, 1.7:1. Up to 20% of pts have a positive family Hx.

Inflammatory mediators activate the coagulation cascade in local blood vessels.

Increased interleukin-17 level is being investigated as having a cause or effect connection between IBD and inhalational anesthetics.

Chronic steroid use can cause adrenal insufficiency and delayed wound healing.

Diarrhea causing metabolic acidosis, hypokalemia, lyte abnormalities, intravascular volume depletion

Defects in bleeding or clotting due to activation of coagulation cascade

Bowel distention precluding use of nitrous oxide and increasing risk of perforation.

Extracolonic manifestations: Primary sclerosing cholangitis and/or cirrhosis of the liver: choose appropriate anesthetics, analgesics, and NMBs. Ankylosing spondylitis: Limited cervical ROM, restrictive pulm mechanics.

Indications for surgery include toxic megacolon, colonic perforation, massive hemorrhage, obstruction, and cancer prevention or resection. If pt is presenting for surgery, disease is in progressive stage and operation can be urgent/emergent in nature.

Pts may have steroid dependence, hypovolemia, electrolyte imbalance, malnutrition, hypoalbuminemia, anemia, bleeding.

Sulfasalazine is the mainstay of treatment for all stages of disease. Side effects include blood dyscrasias, aplastic anemia, hemolytic anemia, hepatitis, pancreatitis, nephrotoxicity, hypersensitivity pneumonitis, and impaired folate absorption.