Gastroenterology: Ulcerative Colitis

Question 1

Describe UC

Answer 1

A recurrent, inflammatory and ulcerating disease of the COLON

Question 2

How does the disease characteristically present?

Answer 2

Rectal bleeding
Diarrhoea
Colicky pain

Question 3

Can weight loss and growth failure occur?

Answer 3

Yes but less common than in Crohns

Question 4

What extra intestinal features are there?

Answer 4

Erythema nodosum

Arthritis

Question 5

How is it diagnosed?

Answer 5

Endoscopy - upper and ileocolonoscopy
Histological features
(After exclusion of infective colitis)

Question 6

Where does it occur?

Answer 6

Extends from the rectum proximally for a variable length?

Question 7

What percentage of children have pancolitis?

Answer 7

90%

In contrast to adults, who majority have colitis confined to distal colon

Question 8

Are there skip lesions or is it confluent?

Answer 8

Confluent

Question 9

What does histology show?

Answer 9

Mucosal inflammation
Crypt damage - architectural distortion, abscess, crypt loss
Ulceration

Question 10

Is the ulceration transmural?

Answer 10

No

Question 11

Why is small bowel imaging required?

Answer 11

To check for extra colonic inflammation - suggestive of Crohn’s disease

Question 12

What investigations should be done?

Answer 12

FBC, ESR, CRP, U&E, LFTs, clotting
Blood culture
Stool sample - exclude campylobacter, shigella, c.difficile
Faecal calprotectin - test for GI inflammation

Question 13

What is used for induction and maintenance therapy in mild disease?

Answer 13

Aminosalicylates e.g mesalazine

Question 14

Disease confined to rectum and sigmoid colon (rare in children) may be managed with what?

Answer 14

Topical steroids

Question 15

What does aggressive or extensive disease require?

Answer 15

Systemic steroids

Immunomodulatory therapy e.g azathioprine alone to maintain remission or in combination with low dose corticosteroids

Question 16

How can resistant disease be managed?

Answer 16

Biological therapy - infliximab or cyclosporin

Question 17

When is colectomy with an ileostomy indicated?

Answer 17

Severe fulminating disease, which may be complicated with a toxic megacolon or for chronic poorly controlled disease

Question 18

What is there an increased incidence of in adults?

Answer 18

Adenocarcinoma of colon - regular colonoscopic screening done after 10 years from diagnosis

Question 19

How should severe fulminating disease be managed?

Answer 19

IV fluids
IV steroids

If this fails to induce remission: ciclosporin may be used
If no improvement: colectomy

Question 20

What monitoring is necessary for mesalazine ?

Answer 20

Renal function before, 3 months after starting then annually
More frequently if renal impairment