UC Flashcards
Location of GI tract
Rectum -> proximal spread along colon
Backwash ileitis is common - crohn’s occurs everywhere in GI tract but UC is usually confined to rectum and colon - backwash ileitis is overspill of inflammation affecting small intestine
What becomes inflammed?
Continuous inflammation of mucosa
Epidemiology
Young adults - mostly female
Cancer Risk
Colorectal cancer
Alleviating factors
Tobacco is protective
Macroscopic changes (4)
- Red mucosa
- Inflamed mucosa
- Mucosa easily bleeds
- Pseudopolyps appear to be present in severe cases adjacent to areas of extensive ulceration
Microscopic changes (4)
- superficial inflammation
- chronic inflammatory cell infiltrate in the lamina propria
crypt abscesses
goblet cell depletion
Investigation
- Colonoscopy is the gold standard for diagnosis but also for measuring extent and progression of disease
- X-ray - to differentiate between Crohn’s by ruling out colonic dilation. Collar button ulcers will be seen - ulcer through the bowel mucosa to muscle then up and down in a T shape
Management if distal
Topical or suppository corticosteroids
Management if left sided colitis (descending bit of colon)
Topical corticosteroid enema
Management if extensive colitis
Oral corticosteroids and Infliximab
What is infliximab
Anti-TNF antibodies that bind to membrane bound TNF-alpha and induce immune cell apoptosis
What if your patient had complications or had a corticosteroid dependency problem - how would you manage them?
Subtotal colectomy with end ileostomy and preservation of the rectum is the operation of choice in acute problems
Presentation (3)
Rectal bleeding, diarrhoea, abdo pain
