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Gastrointestinal > Ulcerative colitis > Flashcards

Ulcerative colitis Flashcards

1
Q

Define ulcerative colitis

A

Chronic relapsing & remitting inflammatory disease affecting the large bowel

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2
Q

Aetiology of ulcerative colitis

3

A

UNKNOWN
Possible genetic susceptibility
Positive FH in 15% patients

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3
Q

Associations of ulcerative colitis

2

A

pANCA

Primary sclerosing cholangitis (70% have UC)

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4
Q

Other factors involved in ulcerative colitis

4

A

Immune response to bacterial or self antigens
Environmental factors
Altered neutrophil function
Abnormality in epithelial cell integrity

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5
Q

Epidemiology of ulcerative colitis

ethnicity, age x2, gender

A

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

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6
Q

Presenting symptoms of ulcerative colitis

6

A 
Bloody or mucous diarrhoea (frequency depends on severity of disease)
Tenesmus & urgency
Crampy abdo pain before passing stool
Weight loss
Fever
Extra GI manifestations
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7
Q

Extra GI manifestations of ulcerative colitis

4

A

Uveitis
Scleritis
Erythema nodosum
Pyoderma gangrenosum

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8
Q

Signs of ulcerative colitis on physical examination

7

A 
Signs of iron deficiency anaemia (e.g. conjunctival pallor)
Dehydration
Clubbing
Abdo tenderness
Tachycardia
Blood, mucus & tenderness on PR exam
Extra GI manifestations
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9
Q

Investigations for ulcerative colitis

5

A 
Blood
Stool
AXR
Flexible sigmoidoscopy or colonoscopy (& biopsy)
Barium enema
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10
Q

Investigations for ulcerative colitis - blood

4

A

FBC - low Hb & high WCC
High ESR or CRP
Low albumin
Cross match if severe blood loss

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11
Q

Investigations for ulcerative colitis - stool

2

A

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

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12
Q

Investigations for ulcerative colitis - AXR

A

Rule out toxic megacolon

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13
Q

Investigations for ulcerative colitis - flexible sigmoidoscopy/colonoscopy
(3)

A

Determines severity
Histological confirmation
Detection of dysplasia

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14
Q

Investigations for ulcerative colitis - barium enema

4

A

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

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15
Q

Management of ulcerative colitis grouped into…

6

A 
Markers of disease activity 
Acute exacerbation
Mild disease
Moderate to severe disease
Advice
Surgical
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16
Q

Management of ulcerative colitis - markers of disease activity
(6)

A 
Decreased Hb
Decreased albumin
Increased ESR & CRP
Diarrhoea frequency:
<4 mild
4-6 moderate 
6+ severe
Bleeding
Fever
17
Q

Management of ulcerative colitis - acute exacerbation

7

A 
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
18
Q

Management of ulcerative colitis - mild disease

A

Oral or rectal 5-ASA derivatives &/or rectal steroids

19
Q

Management of ulcerative colitis - moderate to severe disease
(3)

A

Oral steroids
Oral 5-ASA
Immunosuppression

20
Q

Management of ulcerative colitis - advice

3

A

Patient education & support
Treat complications
Regular colonoscopies surveillance

21
Q

Management of ulcerative colitis - surgical

indication +2

A

INDICATION -
If medical treatment fails, in presence of complications or to prevent colonic carcinoma

Proctocolectomy w/ ileostomy
Ileo-anal pouch formation

22
Q

Complications of ulcerative colitis grouped into…

2

A

GI

Extra GI

23
Q

Complications of ulcerative colitis - GI

6

A 
Haemorrhage 
Toxic megacolon
Perforation
Colonic carcinoma
Gallstones
Primary sclerosing cholangitis
24
Q

Complications of ulcerative colitis - extra GI

9

A 
Uveitis
Renal calculi
Arthropathy
Sacroiliitis
Ankylosing spondylitis
Erythema nodosum
Pyoderma gangrenosum
Osteoporosis (from chronic steroid use)
Amyloidosis
25
Q

Prognosis of ulcerative colitis

A

Normal life expectancy

26
Q

Poor prognostic factors of ulcerative colitis

6

A 
Low albumin (<30g/L)
PR blood
Raised CRP
Dilated loops of bowel
8+ bowel movements daily
Fever

Gastrointestinal (52 decks)

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