Ulcerative colitis involves primarily the mucosa and submucosa. Microscopically, the disease is characterized by mucosal inflammation with the formation of crypt abscesses, epithelial necrosis, and mucosal ulceration. The submucosa, muscular layer, and serosa are often spared. In the usual case, the disease increases in severity more distally, the rectosigmoid being involved in 95 percent of cases. In the early stages of the disease, the mucous membranes appear finely granular and friable. In more severe cases, the mucosa appears as a red, spongy surface dotted with small ulcerations oozing blood and purulent exudate. In very advanced disease, one sees large, oozing ulcerations and pseudopolyps (areas of hyperplastic overgrowth surrounded by inflamed mucosa).

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