UC Flashcards
What is UC?
Chronic inflammatory ulcerative disease affecting mucosa of rectum and colon
Where does UC normally occur?
Starts in rectum and moves proximally
Rectum most common site
What is the histology in UC?
Continuous inflammation Confined to mucosa Raw, red mucosa that bleeds easily Crypt abscesses and ulceration Pseudopolyps
Who is UC seen in?
15-30yo= major peak 50-70yo= minor peak
What are the features of UC?
Bloody diarrhoea Urgency Passage of mucus Abdo pain Lethargy, malaise Arthritis, uveitis, clubbing
What are the features of a severe attack of UC?
Stool frequency >6x/d with blood Fever >37.5 Tachycardia >90 High CRP Anaemia Low albumin Leucocytosis, thrombocytosis
What investigations are done in UC?
Bloods- raised CRP and ESR, anaemia, pANCA +
Raised faecal calprotectin
Colonoscopy and biopsy- diagnostic
What investigations are done in an acute attack of UC?
Daily bloods- FBC, U&Es, albumin
AXR
Erect CXR
CT
How is a severe attack of UC managed?
Hospital admission and IV prednisolone
Infliximab if non responsive disease
How is a mild to moderate attack of UC managed?
Topical aminosalicylate
What are the indications for surgery in acute attack of UC?
Failure to respond to medical management
Toxic megacolon
Perforation
Massive haemorrhage
What are the indications for surgery in chronic UC?
Failure of medical management
Continuous disabling symptoms
Carcinoma, dysplasia or high risk of carcinoma
What surgery is done in acute UC?
Total colectomy, ileostomy and EITHER
- closure of rectal stump OR
- rectosigmoid mucus fistula
What revision surgery is done after acute UC surgery?
Excision of rectuma nd permanent ileostomy OR
Ileal pouch
What surgery is doe in chronic UC?
Total proctocolectomy and EITHER
- permanent ileostomy OR
- ileal pouch
What are the indications for an ileal pouch?
Young person,
continent
UC
What are the contraindications for an ileal pouch?
Crohn’s
anal incontinence
What are the local complications of UC?
High risk colorectal cancer Blood loss and anaemia Protein loss Toxic megacolon Perforation
What is done for the colorectal cancer risk in UC?
Remove any strictures as likely to become cancerous
Surveillance colonoscopy
-total colitis >10 years
-left sided colitis >15 years
What is toxic megacolon?
Transverse or right colon with diameter >6cm with loss of haustration
What is the management of toxic megacolon?
Medical management
Failure to make dramatic improvement in 48 hours –> surgery
How is a perforation detected in UC?
AXR and erect CXR
Physical signs not reliable due to immunomodulation
What are the systemic complications of UC?
Large joint disease Uveitis Spondylitis Liver disease Increased risk cholangiocarcinoma Skin- erythema nodosum
What are the options for maintaining remission in UC?
- 5ASA
- Azathiprine
- Infliximab
