Ulcerative Colitis Flashcards
What is ulcerative colitis?
Ulcerative colitis is an inflammatory bowel disease (IBD) that causes inflammation and ulcers in your digestive tract. Ulcerative colitis affects the innermost lining of your large intestine and rectum. Symptoms usually develop over time, rather than suddenly.
What part of the GI is inflamed in UC?
Ulcerative colitis can affect the rectum alone (proctitis), can extend proximally to involve the sigmoid and descending colon (left-sided colitis), or may involve the whole colon (extensive colitis)
What is proctitis?
Ulcerative colitis of the rectum
What is left-sides colitis?
Ulcerative colitis of the rectum, sigmoid and descending colon
What is the age of onset for UC?
15-35 and 55-70
How does smoking relate to ulcerative colitis?
Protective factor
What causes ulcerative colitis?
The cause of UC is unknown. Theories involve immune system dysfunction, genetics, changes in the normal gut bacteria, and environmental factors.
What are microscopic changes seen in ulcerative colitis?
- The mucosa shows a chronic inflammatory cell infiltrate in the lamina propria.
- Crypt abscesses
- Goblet cell depletion
What are macroscopic chances seen in ulcerative colitis?
- Mucosa looks reddened and inflamed, it bleeds easily. Inflammation is continuous
- In severe disease, there is extensive ulceration with the adjacent mucosa appearing as inflammatory (pseudo) polyps
What are the symptoms of ulcerative colitis?
The major symptom in UC is diarrhoea with blood and mucus, sometimes accompanied by lower abdominal discomfort
General features:
- Malaise
- fatigue
- Anorexia
- Aphthous ulceration in the mouth
- Tenesmus
What are symptoms specific to proctitis?
Proctitis is characterized by the frequent passage of blood and mucus, urgency and tenesmus. There are normally few constitutional symptoms and the stool when passed, may be solid. Patients are nevertheless greatly inconvenienced by the frequency of defecation.
What is the course of ulcerative colitis?
The disease can be mild, moderate and severe and often runs a course of remissions and exacerbations. Of the patients, 10% have persistent chronic symptoms, while some patients may have only a single attack.
How is ulcerative colitis diagnosed?
Presence of chronic diarrhoea for more than 4 weeks and presence of acute inflammation on endoscopy and chronic changes on biopsy
What would a colonoscopy in ulcerative colitis show?
Endoscopic findings in ulcerative colitis include erythema (redness of the mucosa), friability of the mucosa, superficial ulceration, and loss of the vascular appearance of the colon
Histologic findings in ulcerative colitis includes distortion of crypt architecture, crypt abscesses, and inflammatory cells in the mucosa. Limited inflammation only in mucosa
What are the aims of drug treatment in ulcerative colitis?
- Treat acute attack
2. Prevent relapse
How is ulcerative colitis managed pharmacologically?
The therapeutic treatment for UC includes 5-aminosalicylic acid (5-ASA)
The aminosalicylates have been shown to be effective in inducing remission in mild to moderately active disease and maintaining remission in all forms of disease
Corticisteroids are used in more severe cases
What is the mechanism of action of 5-aminosalicylic acid (5-ASA)?
5-aminosalicylic acid is now believed to act by activating a class of nuclear receptors involved in the control of inflammation, cell proliferation, apoptosis and metabolic function, the gamma form of peroxisome proliferator-activated receptors.
Can ulcerative colitis be managed surgically?
While the treatment of UC remains primarily medical, surgery continues to have a central role because it may be life-saving, is curative and eliminates the long-term risk of cancer
The main indication for surgery is for a severe attack which fails to respond to medical therapy
What are poor prognostic factors for ulcerative colitis?
Age < 40 on onset
Extensive colitis
Severe colitis on endoscopy
Elevated CRP and low serum albumin
What are the oncological risks of ulcerative colitis?
The risk of colorectal cancer is significantly increased in people with ulcerative colitis after ten years if involvement is beyond the splenic flexure.
What are the mortality risks of ulcerative colitis?
People with ulcerative colitis are at similar or perhaps slightly increased overall risk of death compared with the background population
How does ulcerative colitis differ from crohns?
UC: continuous and uniform inflammation of large bowel
CD: patchy inflammation anywhere in GI (skip lesions)
UC: stool urgency, fatigue, increased bowel movements, mucus in stool
CD: abdominal pain, diarrhoea, weight loss
UC: submucosal and mucosal diarrhoea
CD: transmural
UC: depleted goblet cells, lot of crypt abscesses, potential pseudopolyps
CD: granulomas, goblet cells
What is another name for 5-ASA given in Ulcerative Colitis?
Mesalazine
What dose of mesalazine would you give in ulcerative colitis?
Depends on anatomy
Mild rectosigmoid: 1 gram 4-6 weeks (rectal)
Mild descending colon: 2 grams 4-6 weeks (rectal)
Mild-moderate: 2.4 grams (oral)
Maintenance of remission: 1.2-2.4 grams daily (oral)
