Gastroenterology: Ulcerative Colitis Flashcards
Describe UC
A recurrent, inflammatory and ulcerating disease of the COLON
How does the disease characteristically present?
Rectal bleeding
Diarrhoea
Colicky pain
Can weight loss and growth failure occur?
Yes but less common than in Crohns
What extra intestinal features are there?
Erythema nodosum
Arthritis
How is it diagnosed?
Endoscopy - upper and ileocolonoscopy
Histological features
(After exclusion of infective colitis)
Where does it occur?
Extends from the rectum proximally for a variable length?
What percentage of children have pancolitis?
90%
In contrast to adults, who majority have colitis confined to distal colon
Are there skip lesions or is it confluent?
Confluent
What does histology show?
Mucosal inflammation
Crypt damage - architectural distortion, abscess, crypt loss
Ulceration
Is the ulceration transmural?
No
Why is small bowel imaging required?
To check for extra colonic inflammation - suggestive of Crohn’s disease
What investigations should be done?
FBC, ESR, CRP, U&E, LFTs, clotting
Blood culture
Stool sample - exclude campylobacter, shigella, c.difficile
Faecal calprotectin - test for GI inflammation
What is used for induction and maintenance therapy in mild disease?
Aminosalicylates e.g mesalazine
Disease confined to rectum and sigmoid colon (rare in children) may be managed with what?
Topical steroids
What does aggressive or extensive disease require?
Systemic steroids
Immunomodulatory therapy e.g azathioprine alone to maintain remission or in combination with low dose corticosteroids
How can resistant disease be managed?
Biological therapy - infliximab or cyclosporin
When is colectomy with an ileostomy indicated?
Severe fulminating disease, which may be complicated with a toxic megacolon or for chronic poorly controlled disease
What is there an increased incidence of in adults?
Adenocarcinoma of colon - regular colonoscopic screening done after 10 years from diagnosis
How should severe fulminating disease be managed?
IV fluids
IV steroids
If this fails to induce remission: ciclosporin may be used
If no improvement: colectomy
What monitoring is necessary for mesalazine ?
Renal function before, 3 months after starting then annually
More frequently if renal impairment
