UC

Question 1

define?

Answer 1

chronic mucosal inflammation of the colon specifically the rectum (unlike crohns) with no skip lesions.

Question 2

symptoms of UC?

Answer 2

-fever, fatigue
-bloody diarrhea with mucus
-fecal urgency
-colicky abdomen pain
-extraintestinal (less common than crohns): pyoderma gangrenosum, erythema nodosum, apthous ulcer, uveitis, athritis

-primary sclerosing cholangitis

Question 3

what measures disease severity in UC vs crohns?

Answer 3

crohns: endoscopy
UC: CRP and ESR

Question 4

what lab and imaging tests to order? pathology?

Answer 4

-CBC: anemia, high WBC
-CRP, ESR: high
-ALP and GGT if suspecting PSC
-stool PCR, culture and microscopy to rule out gastroenteritis
-stool calprotectin can indicate inflammation severity

-abdomen xray: lead pipe appearance due to loss of haustra in severe cases
-endoscopy with biopsy: erythema, edema, psuodopolyp, loss of haustra, ulcers

pathology: mucosal atrophy, crypt abscess

Question 5

medications for induction of remission?

Answer 5

mild to moderate: 5 ASA with/out steroid
moderate to severe: steroid
severe: steroid

maintenance use non steroid agents like biologic and immunomodulators

Question 6

surgery? indications? screening?

Answer 6

indications: failure of medical therapy, toxic megacolon, bowel perforation, cancer or dysplasia

surgery is curative unlike in crohns

proctocolectomy with ileal pouch-anal anastomosis
-entire colon is removed
-loops of small intestine is used to create an artificial rectum (conserves continence)

colorectal cancer screening starts 10 years after diagnosis and repeated every 1-5 years: endoscopy for biopsies

Question 7

complications?

Answer 7

colorectal cancer, toxic megacolon, strictures, perforation