Ulcerative colitis is known to cause all of the following except:
(REF. SABISTON SURGERY 18TH EDN CHP 48 PG 1682)
a. Extraintestinal manifestations of ulcerative colitis include arthritis, ankylosing spondylitis, erythema nodosum, pyoderma gangrenosum, and primary sclerosing cholangitis.
b. Arthritis, particularly of the knees, ankles, hips, and shoulders, occurs in about 20% of patients, typically in association with increased activity of the intestinal disease.
c. Ankylosing spondylitis occurs in 3% to 5% of patients and is most prevalent in patients who are HLA-B27 positive or have a family history of ankylosing spondylitis.
d. Erythema nodosum arises in 10% to 15% of patients with ulcerative colitis and often occurs in conjunction with peripheral arthropathy.
e. Pyoderma gangrenosum typically presents on the pretibial region as an erythematous plaque that progresses into an ulcerated, painful wound. Most patients who develop this condition have underlying active inflammatory bowel disease.
f. Arthritis, ankylosing spondylitis, erythema nodosum, and pyoderma gangrenosum typically improve or completely resolve after colectomy.
g. Primary sclerosing cholangitis (PSC) occurs in 5% to 8% of patients with ulcerative colitis. Most patients with inflammatory bowel disease who develop PSC are younger than 40 years of age, and the majority are men.
h. Patients with ulcerative colitis who have the HLA-B8 or HLA-DR3 haplotype are 10 times more likely to develop PSC.
i. These tumors are more likely to arise proximal to the splenic flexure.
j. The disease is progressive and ultimately fatal unless liver transplantation is undertaken. Colectomy has no effect on the course of disease.