2+ Ulcerative Colitis Flashcards
What is ulcerative colitis?
An IBD associated with inflammation from the rectum that extends proximally and not beyond the ileocaecal valve.
What is the epidemiology of ulcerative colitis?
More common than Crohn’s
Peak incidence is teens/20s and 50-60
What is the aetiology of ulcerative colitis?
- Occurs in genetically susceptible people in response to environmental triggers
- Probably an AI disease initiated by an inflammatory response to colonic bacteria
What is the pathophysiology of ulcerative colitis?
Proctitis: inflammation limited to the rectum
Protosigmoiditis: inflammation extending to sigmois
Extensive disease: can reach the ileocaecal valve
What are the macroscopic features of ulcerative colitis?
Widespread ulceration with preservation of adjacent mucosa which has the appearance of polyps –> pseudopolyps
Continuous disease
What are the microscopic features of ulcerative colitis?
No inflammation beyond the submucosa!!
- Neutrophils migrate through the walls of glands to form CRYPT ABSCESSES
- DEPLETION OF GOBLET CELLS and mucin
- Granulomas are infrequent
- Shortening of the crypts
What are the radiological features of ulcerative colitis on barium enema?
Loss of haustration
Superficial ulceration with pseudopolyps
Drainpipe colon: colon is narrow and short
What is the clinical presentation of ulcerative colitis?
- Bloody diarrhoea
- Rectal bleeding with mucous
- Rectal urgency
- Tenesmus
- Abdominal pain- particularly LLQ
- Extra-intestinal features
- Fam Hx
What Ix do you do for suspected ulcerative colitis?
- Stool MCS
- Faecal calprotectin
- FBC: anaemia
- Flexible sigmoidoscopy
- Colonoscopy with biopsy
How do you treat acute moderate-severe ulcerative colitis?
Acute Severe:
1. Admit to hospital
2. IV corticosteroids
3. Supportive: blood transfusion, fluid and electrolyte replacement, VTE prophylaxisis
4. Biological agent: infliximab, adalimumab
5. Immunomodulators: azathioprine, mercaptopurine
6. if they don’t induce remission: tofacitinib
7. Colectomy: if severe intractable symptoms or intolerable to SEs
How do you maintain remission in moderate-severe ulcerative colitis?
- Infliximab or thiopurine (mercaptopurine or azathioprine)
- Other biological agents after a thiopurine
- Tofacitinib
How do you manage mild proctitis from UC?
Topic aminosalicylate
How do you manage mild left-sided colitis in UC?
Oral aminosalicylate (sulfasalazine, mesalazine)
And budesonide
How do you manage mild extensive colitis?
Oral aminosalicylate
Oral corticosteroid
What are the complications of ulcerative colitis?
Much greater risk of colonic adenocarcinoma
Associated with PSC
Perforation
Benign stricture
Massive lower GI bleed
