Chapter 50: IBD- Ulcerative Colitis Flashcards
Incidence?
10/100,000
At-risk population
- High in the Jewish population
- low in the African American population
- Positive family history in 20% of cases
Sex?
Male > female
Distribution?
Bimodal distribution at
- 20 to 35 and
- 50 to 65 years of age
Initial symptoms
Bloody diarrhea (hallmark)
fever
weight loss
Anatomic distribution
Colon only
Route of spread
Almost always involves the rectum and spreads proximally always in acontinuous route without “skip areas”
What is “backwash” ileitis?
Mild inflammation of the terminal ileum in ulcerative colitis; thought to be “backwash” of inflammatory mediators from the colon into the terminal ileum
Bowel wall involvement
Mucosa/submucosa only
Anal involvement
Uncommon
Rectal involvement
100%
Mucosal Findings
- Granular, flat mucosa
- Ulcers
- Crypt abscess
- Dilated mucosal vessels
- Pseudopolyps
Diagnositc tests
- Colonoscopy
- barium enema
- UGI with small bowel follow through (to look forCrohn’s disease)
- stool cultures
Complications
- Cancer
- toxic megacolon
- colonic perforation
- hemorrhage
- strictures
- obstruction
- complications of surgery
Cancer risk
- ≈5% risk of developing colon cancer at 10 years;
- then, risk increases ≈1% per year;
- thus, an incidence of ≈20% after 20 years of the disease (30% at 30 years)
Indications for surgery
- Toxic megacolon
- (refractory to medical treatment);
- cancer prophylaxis
- massive bleeding
- failure of child to mature because of disease and steroids
- perforation
- suspicion of or documented cancer
- acute severe symptoms refractory to medical treatment
- inability to wean off of chronic steroids
- obstruction
- dysplasia
- stricture
What are the common surgical options for ulcerative colitis?
- Total proctocolectomy, distal rectal mucosectomy, and ileoanal pull through
- Total proctocolectomy and Brooke ileostomy
What is “toxic megacolon”?
- Toxic patient: sepsis, febrile, abdominal pain
- Megacolon: acutely and massively distended colon
24-year-old man with ulcerative colitis receives Lomotil® for excessive diarrhea and develops fever, abdominal pain and tenderness, and a massively dilated colon on abdominal x-ray
Toxic megacolon
28-year-old man with nonbloody diarrhea, low-grade fever,abdominal pain, perirectal abscesses, perianal fistulae
Crohns
