IBD- Ulcerative Colitis Flashcards
what is it?
chronic inflammatory ulcerative disease affecting colon and rectum, NOT anal canal
where does it affect?
- inflammation affects mucosa and submucosa
- extends proximally from rectum
what is a characteristic feature seen?
pseudopolyps - attempts at healing produce epithelial thickening in between ulcers
pathophysiological changes? both micro and macroscopic
- Macroscopic
- red, inflamed mucosa
- continuous inflammation
- friable
- inflammatory polyps
- Microscopic
- crypt asbcesses
- inflammatory infiltrates & oedema
what is the most common –> least common part of colon/rectum affected?
- proctitis
- left-sided colitis
- pan-colitis
what are pts with pan-colitis at risk of developing?
backwash ileitis - reflux of colonic contents into ileum
aetiology?
- Genetics: genetic predisposition
- Immune system: abnormal immunological response to normal intestinal flora
- Environmental: smoking is PROTECTIVE
epidemiology?
- bimodal peak
- major peak: 15-30
- minor peak: 50-70
symptoms?
hallmark= bloody diarrhoea / rectal bleeding
- abdo pain
- wt loss
- tenesmus
describe the fulminating type
- bowel movements >10/24h
- fever, tachycardia, continuous bleeding, anaemia & hypoalbuminaemia
- abdominal distension- TOXIC MEGACOLON
- major complication of UC!!
describe toxic megacolon
- transverse/right colon diameter >6cm
- occurs in 5% of attacks
- can be triggered by electrolyte abnormalities and narcotics
- Mx
- 50%- medical therapy alone
- urgent colectomy for those who don’t improve - perforation is most dangerous local complication
- ALWAYS suspect possibilty as can have a silent perforation
describe chronic type
initial attack of moderate severity followed by recurrent exacerbations
signs?
- pyrexia, dehydration
- abdo tenderness, distension
- tachycardia
- hypotension
extra-intestinal: as CD but strong association w PSC
Ix?
Diagnosis = macroscopic ie endoscopy & histological evidence ie biopsy
- Bloods
- FBC
- haematinics
- U&E
- B12
- Folate
- CRP
- stool microscopy/ culture
- faecal calprotectin
- endoscopy + biopsy
Imaging:
- AXR
- indicated in acute fulminating colitis to rule out toxic megacolon
- Erect CXR
- free air under diaphragm is due to perforation
- CT abdo
- for acute presentation & to rule out perforation
what findings would be seen on endoscopy?
- loss of normal vascular pattern
- inflamed mucosa & contact bleeding
- mucous pus or blood in lumen
- ulceration granulation tissue & pseudopolyps
Medical Mx?
- Inducing remission
- mild/moderate
- aminosalicyclate ie mesalazine
- 2.corticosteroids
- severe
- IV corticosteroids
- IV ciclosporin
- mild/moderate
- Maintaining
- aminosalicyclate
- azathioprine
- mercaptopurine
indications for surgical Mx in acute
- failure to respond to medical mx
- acute toxic dilatation, unless dramatic response within 48h
- perforation or massive haemorrhage
surgical mx options in ACUTE?
no place for segmental resection in UC
- total colectomy, ileostomy & closure of rectal stump
- total colectomy, ilesotomy & rectosigmoid mucous fistula
indications for surgery in chronic?
- Continuous disabling symptoms
- Carcinoma, dysplasia or risk of developing carcinoma
surgical mx in chronic?
- total proctocolectomy & permanent ileostomy
- total proctocolectomy & formation of ileal pouch (ileo-anal anastomosis)
complications of ileal pouch?
early –> anastomotic complications, intra-abdo abscess
late –> poor function, pouchitis, pouch failure
complications of UC?
- haemorrhage
- toxic megacolon
- perforation–> peritonitis
- colorectal carcinoma
