1. Ulcerative Colitis

Question 1

Epidemiology of UC

Answer 1

• <30y, F=M

- caucasians, Jews & northern EU ancestry

Question 2

Etiology of UC (causes)

Answer 2

• not entirely known
• dietary: inadequate fibers intake, chemical food additive, refined sugars, cows milk
• infectious: C. Difficile & Campylobacter Jejuni
• family: monozygotic twins
• genetic: allele HLA & DR2
  Smocking is “good”

Question 3

Pathological features of UC

Answer 3

• involves mucosa & submucosa of colon without muscularis
• gross appearance: hyperemic mucosa & granular in more severe
• rectum invariably involved with inflammatory process
• rectal involvement is the sine qua non

Question 4

Diagnostic characteristic of UC

Answer 4

Continuous, uninterrupted inflammation of the colonic mucosa beginning at the distal rectum and extending proximally to a variable distance.
The entire colon, including the Cecil and appendix may be involved.

Question 5

Clinical presentation of UC

Answer 5

• diarrhea and the passage of mucous.
• more urgency than in Crohn’s disease because UC is invariable associated with distal proctitis.
• bleeding
• abdominal discomfort, pain is seldom.

Question 6

Extraintestinal manifestations of UC

Answer 6

• Arthritis: knees, ankles, hips and shoulder -> 20% of pt
• Ankulosong spondylitis: 3-5% more in pt with HLA-B27 positive.
• Erythema Nodusum: 10-15% & often occurs in conjunction with peripheral arthropathy.
• Pyoderma Gangrenosum: Pretibial region as an erythematous plaque that progresses into an ulcerated painful wound.
  THEY ALL RESOLVE AFTER COLECTOMY.

Question 7

Diagnosis of UC

Answer 7

Endoscopic examination of the colon and rectum is essential.
In acute phase -> proctosigmoidoacopy.
Complete colonoscopy isn’t so good cause gives little more info and increases risk of perforation.

Question 8

Complications of UC

Answer 8

• Carcinoma: colorectal carcinoma; MC risk factor: prolonged duration of the disease, pancolonic disease, severity of the inflammation.
• perforation: may occur during acute attack or with toxic megacolon. The Pt dev generalized peritonitis and septic shock (30% mortality)
• toxic megacolon: inflammatory process involved full thickness of the bowel with coalescence of crypt abscesses, destruction of the muscle layer and the myenteric plexus and severe dilation of a friable colon.

Question 9

Medical Treatment:

Answer 9

3 broad categories:

• amino salicylates (sulfasalazine)
• corticosteroids (hydrocortisone)
• immunomodulatory drugs

Question 10

Indications for Surgical treatment of UC

Answer 10

• fulminant colitis with toxic mégacôlon
• massive bleeding
• intractable disease
• dysplasia or carcinoma

Question 11

Elective surgical option for UC:

Answer 11

• total proctolectomy with ileostomy
• restorative proctolectomy with IPAA (ideal pouch anal anastomosis)
• total proctolectomy with a continent ill reservoir (kock pouch)
  Inadequate procedure for UC: segmental colectomy