UC

Question 1

How common is UC?

Answer 1

-1-2 in 1000
-Typically presents in 15-30 y/o’s
-3x more common in non-smokers (opposite to Crohn’s)

Question 2

What causes UC?

Answer 2

-Relapsing and remitting inflammation of the colonic mucosa
-Can affect just the rectum, extend to the left-sided colon or involve the whole colon
-Caused by an inappropriate immune response against colonic flora

Question 3

How does UC present?

Answer 3

-Episodic / chronic diarrhoea (+ blood + mucus)
-Crampy abdo pain
-Increased bowel frequency (linked to severity)
-Systemic symptoms - fever, malaise, anorexia, weight loss

Question 4

What signs might a patient with UC have on examination?

Answer 4

-Clubbing
-Aphthous ulcers
-Conjunctivitis, iritis
-Erythema nodosum
-Arthritis

Question 5

How would you investigate a patient with UC?

Answer 5

-FBC, ESR, CRP, U+E, LFT
-Stool sample - MC+S and faecal calprotectin
-Colonoscopy - disease extent + biopsy
-pANCA positive

Question 6

What treatment would you consider for a patient with UC?

Answer 6

Encourage low fibre diet
MILD
-Mesalazine (PR for distal disease, PO if more extensive)
MODERATE
-Prednisolone with gradually weaning doses
SEVERE
-IV hydration if v unwell
-Hydrocortisone + monitor daily to exclude infection / complications
-Eventually switch to prednisolone if improving
-Colectomy if no improvement
MAINTENANCE
-Mesalazine
-Azathiopurine / mercaptopurine