Gastro - Ulcerative colitis Flashcards
(16 cards)
what is UC?
Autoimmune chronic inflammation of the colon that may be triggered by colonic bacteria causing GI tract inflammation.
what is the course of UC?
life-long, relapsing-remitting
which part of the bowel does UC affect?
Limited to colon:
- proctitis (confined to rectum)
- proctosigmoiditis (rectum + sigmoig colon)
- left-sided colitis (rectum to splenic flexure)
- extensive colitis (rectum to hepatic flexure)
- pancolitis (all colon)
name 2 microscopic features of UC
- abnormal crypt architecture, inc. crypt abscesses
2. chronic inflammatory infiltration of lamina propria
name 3 macroscopic features of UC
- loss of haustra (featureless mucosal view)
- widespread irregular superficial ulceration
- pseudopolyps
suggest possible abdo signs and symptoms of UC
Symptoms:
- bloody diarrhoea
- colicky abdo. pain (esp. during diarrhoeal episodes)
- urgency or tenesmus
Signs:
- tenderness
- weight loss
suggest possible extra-abdo features of UC
- systemic Sx: fever, malaise
- eyes: iritis, uveitis, episcleritis
- skin: erythema nodosum, pyoderma gangrenosum
- liver: primary sclerosing cholangitis, hepatitis
- joints: inflammatory arthritis, ankylosing spondylitis
which investigations would you perform on a pt with suspected UC?
Bloods:
- FBC: may show anaemia
- ESR/CRP: inflammation markers, indicate severity
- UandEs and LFTs
- iron studies, vitB12 and folate
- serological markers: p-ANCA more common in UC, ASCA more common in CD
- coeliac screen: total IgA and IgA tTG to rule out coeliac disease
Bedside tests:
- faecal calprotectin: to detect colonic inflammation and rule out functional diarrhoea
- microbiological stool testing: for C. diff toxin and other pathogens, inc. ova, cysts and parasites
- sigmoidoscopy +/- rectal biopsy: considered in all pts with diarrhoea
Imaging:
- AXR: to exclude colonic dilatation and perforation, may help assess disease extent or ID proximal constipation
- colonoscopy + biopsies: 1st line for Dx of colitis, with at least 2 biopsies from 5 diff sites
which UC features may be seen on AXR?
lead-pipe colon
which UC features may be seen on colonoscopy?
- loss of definition
- continuous superficial ulceration with friable mucosa
describe the UC severity index
- mild: <4 stools/day, no more than small amounts of blood in stool, no anaemia, HR <90, no fever, normal ESR and CRP.
- moderate: 4-6 stools/day with more blood, no anaemia, HR <90, no fever, normal ESR and CRP.
- severe: >6 stools/day with visible blood in stools, and at least 1 feature of systemic upset (Temp >37.8, HR >90, anaemia, ESR >30)
which drugs would you suggest to induce remission in mild-moderate UC?
- Proctitis/proctosigmoiditis
- topical and/or oral aminosalicylate (topical or combination therapy work better) - left-sided and extensive UC
- oral and/or topical aminosalicylate OR oral aminosalicylate + oral beclometasone
If no improvement after 4wks of above, add oral prednisolone. If no response after 2-4 wks, add oral tacrolimus.
what management would you suggest to induce remission in acute severe UC?
i. IV corticosteroids
If contra-indicated/no improvement within 72 hrs, add ciclosporin or consider surgery.
what management would you suggest to maintain UC remission?
- 1st line - proctitis/proctosigmoiditis: topical +/- oral aminosalicylate
- 1st line - L-sided/extensive UC: low maintenance dose oral aminosalicylate
- 2nd line - add oral azathioprine or mercaptopurine if 2+ corticosteroid courses required/yr, disease relapses when dose of prednisolone <15 mg/day or disease relapses within 6 wks of stopping steroids
describe a possible type of surgery for UC
restorative protocolectomy with ileal pouch-anal anastamosis (curative)
suggest possible complications of UC
- colorectal cancer: double incidence in UC
- ileal pouch surgery complications: pouchitis, leakage or pelvic abscess
- toxic megacolon: can be triggered by hypokalaemia, opiates, anticholinergics and barium enema
- osteoporosis
