Inflammatory bowel disease: ulcerative colitis Flashcards
when is the peak incidence of ulcerative colitis ?
15-35- mostly
60-80
what is the etiology of ulcerative colitis ?
genetic predisposition - 1st degree relatives
autoimmune condition triggered by bacterial infection sulfide producing bacteria can be an exogenous trigger factor
genetic + environment
what is the pathophsyioogy of ulcerative colitis ?
activation of lymphocytes daily th2
- causing inflammation of mucosa and submucosa due to cytotoxic effect on the colonic epithelium
pANCA - autoantibodies against intestinal epithelium
- target own neutrophils
- might be due to gut bacteria
what is the localisation of ulcerative colitis ?
LOCALISED TO COLON
rectum begins
can extend proximally but only affects mucosa and submucosa f the large intestine = continuous involvement unlike churns which is skip
what is the macroscopic features of UC?
MACROSCOPIC
limited to mucosa and submucosa - and continuous
early
granular mucosa
edematous
spotty bleeding, and bleeding on contact , small ulceration
chronic friable mucosa extensive ulceration fibrin covered loss of mucosal folds haustra loss pseudopolyps shortened colon but normal wall thickness
what is the microscopic features of ulcerative colitis ?
early = granulocyte infiltration
limited to mucosa and submucosa
crypt abcess
GRANULOMAS SHOULD NOT BE PRESENT or FISSURES OR LYMPHOID AGGREGATES
chronic mucosal and glandular atrophy lymphocytic infiltration epithelial dysplasia altered crypt AND ALTERED GLANDS architecture reduction of goblet cells
what are the intestinal symptoms ?
bloody diarrhea with mucus
abdominal pain and cramps
tenesmus
pain:
before or during defecation
mainly left quadrant - tender left lilac fossa
what are the extrainetsinal symptoms of ulcerative colitis ?
eyes - uveitis , iritis , episcelritis
billary :primary sclerosis cholangitis
joints : arthritis (sacroilitpis) , ankylosing spondylitis
skin : erythema nodosum , pyoderma gangrenous
fever
what are the physical examination that can aid diagnosis ?
rectal examination :
tender anal canal and blood
hepatic tympany - megacolon
peritonitis
what are the lab ways of diagnosis of ulcerative colitis ?
blood - ear , cup , leukocytes
anemia
serology - pANCA 60 pecrent and ASCA 5 percent
stool analysis
calprotectin and lactoferrin = indicators for mucosalinflammtion
what is the golden standard for diagnosis ?
colonoscopy and biopsy
double contrast barium enemam
what are the complications with ulcerative colitis disease ?
toxic megacolon
perforation - peritonitis
increased risk of colorectal cancer
amyloidosis
severe dehydration
osteoporosis
severe bleeding
what is the differential diagnosis of ulcerative colitis ?
most important - chrons
infectious colitis
diverticular disease
appendicitis
ischemic colitis
ex
what is the treatment for ulcerative colitis ?
symptomatic
antidiarrheal - loperamide
anticholinergic - propanthelene
mild cases
5- ASA - mesasalazine and sulfasalazine
this can be oral , suppository or enema
========== mild to modeate oral and topical 5-asa topical corticosteroid - budesonide anti TNF therapy - adalimumab and inflximab
=============
severe or refectory
high dose oral and topical 5-ASA
systemic corticosteroids
anti TNF therapy - adalimumab and infliximab
if antiTNF failed
Vedolizumab (integrin receptor antagonist)
Tofacitinib (JAK3 inhibitor)
6-mercaptopurine, azathioprine = considered but not effective as mono therapy anymore
maintenance - cyclosporin / tacromlimus
================
surgery - CAN BE CURED - unlike chrons
surgery - proctolectomy
with ileoanal anastomosis
rectal mucosectomy
what is the Montreal classification for ulcerative colitis ?
extent
e1 - limited to the rectum
e2 - limited to the distal of splenic flexure
e3 - involvement involves proximal tospenic fissure - PANCOLITIS
severity
s0 - asymptomatic - remission
s1 - passage of four or fewer stool per day without blood , abscise of any systemic illness and normal inflammatory markers
s2- passage of more than 4 stool per day
s3 - sever - passage of atleast six bloody stool
pulse rate 90
temp 37.5
haemoglobin less than 10.5g/ dl
crp highand esr
