IBD: Ulcerative Colitis Flashcards
What is Ulcerative Colitis (UC)?
IBD where the inflammation starts at the rectum, never spreads past the ileocaecal valve and is continuous
Peak incidence occurs at ages 15-25 and 55-65.
What are the typical symptoms of Ulcerative Colitis?
- BLOODY + MUSCUS diarrhoea
- Urgency
- Tenesamus
- Abdominal pain (LLQ)
- Fatigue, weight loss, fever (severe disease)
- Extra-intestinal features: Arthritis, uveitis, erythema nodosum, pyoderma gangrenosum, PSC + increase risk of colorectal cancer
What is the gold standard investigation for Ulcerative Colitis?
Colonoscopy + Sigmoidoscopy
Avoid colonoscopy in severe UC; use a flexible sigmoidoscopy instead.
What are the typical findings in a colonoscopy for Ulcerative Colitis?
- Red, raw mucosa + bleeds easily
- No inflammation beyond submucosa
- Widespread ulceration + pseudopolyps + crypt abscesses
- Depletion of goblet cells
- Granulomas are infrequent
- Inflammation cells infiltrate in lamina propria
What findings are associated with a Barium enema in Ulcerative Colitis?
- Loss of haustrations
- Superficial ulceration - ‘pseudopolyps’
Classify Ulcerative Colitis based on stool frequency and systemic upset.
- Mild: < 4 stools/day, only a small amount of blood
- Moderate: 4-6 stools/day, varying amounts of blood, no systemic upset
- Severe: >6 bloody stools per day + features of systemic upset (pyrexia, tachycardia, anaemia, raised inflammatory markers)
What is the management for maintenance of remission following a mild/moderate UC flare for proctitis/proctosigmoidits?
- Topical (rectal) aminosalicylate (daily or intermittent) ALONE
- Oral aminosalicylate ALONE
- Oral aminosalicylate + Topical (rectal) aminosalicylate
What is the remission management for mild/moderate left-sided and extensive Ulcerative Colitis?
Low dose oral aminosalicylate
What should be given following a severe relapse or 2+ exacerbations in 12 months to manage remission?
Oral Azathioprine or oral mercaptopurine
What are common causes of flares in Ulcerative Colitis?
- Stress
- Medications: NSAIDs, antibiotics
- Stopping smoking
What is the first-line treatment for mild/moderate UC flares with proctitis?
Topical (rectal) aminosalicylate (e.g. mesalazine)
What should be done if remission is not achieved in 4 weeks for proctitis UC flare?
Add topical/oral aminosalicylate
What is the next step if remission is still not achieved after adding aminosalicylate for proctitis?
Add topical/oral corticosteroids
What is the first-line treatment for proctosigmoiditis and left-sided ulcerative colitis acute flare?
Topical (rectal) aminosalicylate
What should be done if remission is not achieved in 4 weeks for proctosigmoiditis acute UC flare?
Add high-dose oral aminosalicylate +/- topical corticosteroids
What should be done if remission is still not achieved after adding high-dose aminosalicylate in a mild/moderate UC flare affecting ptoctosigmoiditis?
STOP topical treatment + offer aminosalicylate + oral corticosteroids
What is the first-line treatment for mild/modertae extensive disease flares in UC?
Topical (rectal) aminosalicylate and a high-dose oral aminosalicylate
What should be done if remission is not achieved in 4 weeks for extensive disease for mild/modertae extensive disease flares in UC?
STOP topical treatment + offer high dose aminosalicylate + oral corticosteroids
What is the management for flares in severe Ulcerative Colitis?
ADMIT and 1st line: IV steroids (IV ciclosporin if steroids contraindicated)
What should be done if there is no improvement after 72 hours of treatment for severe UC?
ADD IV ciclosporin or consider surgery
What is defined as a severe UC flare?
