PAEA Surgery End Of Rotation (EOR) Practice Exam

How does ulcerative colitis typically spread in the colon?

1. In a discontinuous manner

2. Proximally in a continuous route

3. Randomly throughout the colon

4. From distal to proximal

The correct answer is: Proximally in a continuous route

Ulcerative colitis is characterized by its inflammation and ulceration of the colonic mucosa, which typically occurs in a continuous manner, starting from the rectum and extending proximally to involve more of the colon. This contiguous pattern of involvement can vary in extent but is essential to understanding the progression of the disease. As the inflammation progresses, it may involve the entire colon (total colitis) or be confined to certain sections, but it always maintains a continuous relationship and does not skip areas or affect parts of the colon in a patchy manner. The clarity of this progression is crucial in clinical practice for diagnosis and management strategies. Recognizing that ulcerative colitis starts at the rectum and moves in a proximal direction helps differentiate it from Crohn's disease, which can have a discontinuous or "skip" lesion pattern. The continuous nature of ulcerative colitis also impacts surveillance strategies for colorectal cancer as areas of dysplasia can develop in an uninterrupted manner along the affected segment. Therefore, understanding the typical pattern of spread reinforces key concepts in pathology, treatment options, and monitoring for complications.