Ulcerative colitis Flashcards
Define ulcerative colitis
Chronic relapsing & remitting inflammatory disease affecting the large bowel
Aetiology of ulcerative colitis
3
UNKNOWN
Possible genetic susceptibility
Positive FH in 15% patients
Associations of ulcerative colitis
2
pANCA
Primary sclerosing cholangitis (70% have UC)
Other factors involved in ulcerative colitis
4
Immune response to bacterial or self antigens
Environmental factors
Altered neutrophil function
Abnormality in epithelial cell integrity
Epidemiology of ulcerative colitis
ethnicity, age x2, gender
Higher prevalence in Ashkenazi Jews & caucasians
Peak onset 20-40 yrs
Uncommon before 10 yrs old
Equal sex ratio up to age 40 then higher in males
Presenting symptoms of ulcerative colitis
6
Bloody or mucous diarrhoea (frequency depends on severity of disease) Tenesmus & urgency Crampy abdo pain before passing stool Weight loss Fever Extra GI manifestations
Extra GI manifestations of ulcerative colitis
4
Uveitis
Scleritis
Erythema nodosum
Pyoderma gangrenosum
Signs of ulcerative colitis on physical examination
7
Signs of iron deficiency anaemia (e.g. conjunctival pallor) Dehydration Clubbing Abdo tenderness Tachycardia Blood, mucus & tenderness on PR exam Extra GI manifestations
Investigations for ulcerative colitis
5
Blood Stool AXR Flexible sigmoidoscopy or colonoscopy (& biopsy) Barium enema
Investigations for ulcerative colitis - blood
4
FBC - low Hb & high WCC
High ESR or CRP
Low albumin
Cross match if severe blood loss
Investigations for ulcerative colitis - stool
2
Infectious colitis is a differential so stool culture may be useful
Faecal calprotectin allows differentiation of IBS from IBD
raised in inflammatory processes (IBD)
both can present w/ long term diarrhoea
Investigations for ulcerative colitis - AXR
Rule out toxic megacolon
Investigations for ulcerative colitis - flexible sigmoidoscopy/colonoscopy
(3)
Determines severity
Histological confirmation
Detection of dysplasia
Investigations for ulcerative colitis - barium enema
4
Shows mucosal ulceration w/ granular appearance & filling defects (due to pseudo polyps)
Narrowed colon
Loss of haustral pattern - lead pipe appearance
Colonoscopy & barium enema may be DANGEROUS during acute exacerbation - risk of perforation
Management of ulcerative colitis grouped into…
6
Markers of disease activity Acute exacerbation Mild disease Moderate to severe disease Advice Surgical
Management of ulcerative colitis - markers of disease activity
(6)
Decreased Hb Decreased albumin Increased ESR & CRP Diarrhoea frequency: <4 mild 4-6 moderate 6+ severe Bleeding Fever
Management of ulcerative colitis - acute exacerbation
7
IV rehydration IV corticosteroids Antibiotics Bowel rest Parenteral feeding may be necessary DVT prophylaxis If toxic megacolon - patient likely to need proctocolectomy due to high mortality
Management of ulcerative colitis - mild disease
Oral or rectal 5-ASA derivatives &/or rectal steroids
Management of ulcerative colitis - moderate to severe disease
(3)
Oral steroids
Oral 5-ASA
Immunosuppression
Management of ulcerative colitis - advice
3
Patient education & support
Treat complications
Regular colonoscopies surveillance
Management of ulcerative colitis - surgical
indication +2
INDICATION -
If medical treatment fails, in presence of complications or to prevent colonic carcinoma
Proctocolectomy w/ ileostomy
Ileo-anal pouch formation
Complications of ulcerative colitis grouped into…
2
GI
Extra GI
Complications of ulcerative colitis - GI
6
Haemorrhage Toxic megacolon Perforation Colonic carcinoma Gallstones Primary sclerosing cholangitis
Complications of ulcerative colitis - extra GI
9
Uveitis Renal calculi Arthropathy Sacroiliitis Ankylosing spondylitis Erythema nodosum Pyoderma gangrenosum Osteoporosis (from chronic steroid use) Amyloidosis
Prognosis of ulcerative colitis
Normal life expectancy
Poor prognostic factors of ulcerative colitis
6
Low albumin (<30g/L) PR blood Raised CRP Dilated loops of bowel 8+ bowel movements daily Fever
