Ulcerative Colitis Flashcards
What is ulcerative colitis?
Relapsing remitting inflammatory disorder of the colonic mucosa
What is the pneumonic for features of UC?
CLOSE UP
What does CLOSE UP stand for?
C- Continuous inflammation L- Limited to colon and rectum O- Only superficial mucosa affected S- Smoking is preventative E- Excrete blood and mucus U- Use aminosalicylates P- Primary sclerosing cholangitis
When does UC usually develop before?
Before the age of 34
How does the inflammation in the colon present?
One continuous band of inflammation
How does UC usually present?
Diarrhoea
Abdominal pain-LLQ
Weight loss- Due to abdo pain
What does the diarrhoea usually include?
Blood and Mucus
When does the abdominal pain usually occur?
After eating
Where does the abdominal pain usually occur?
In the LLQ
Why does a patient tend to lose weight with UC?
Abdominal pain which comes on after eating
Patient tends to avoid eating
What is the main investigation for UC?
Endoscopy and biopsy
What would you see on colonoscopy and biopsy?
- No inflammation beyond the submucosa
- Pseudopolyps (superficial ulceration)
- Depletion of goblet cells
- Continuous disease- no skip lesions
- Crypt abscesses (neutrophils migrate to wall)
- Drainpipe colon (colon narrowed and short)
What else can be used to diagnose UC?
- p-ANCA positive
- Faecal calprotectin
- Barium enema- loss of haustrations
How often is P-ANCA positive?
70% of cases
What are possible complications of UC?
Toxic megacolon
Fissures
Abscess
What is used to induce remission in mild disease?
Aminosalicylates- Mesalazine
What would you add if aminosalicylates weren’t controlling the disease?
Prednisolone
What is used to induce remission in severe UC disease?
IV hydrocortisone
OR
IV ciclosporin
What is the management of a flare up of UC?
IV hydrocortisone
What is used to maintain remission in UC?
Aminosalicylates: Azaithoprine or Mesalazine
What is used to assess a flare up of UC?
Truelove and Witts severity index
What is classed as a severe flare up of UC?
More than 6 stools a day plus:
• Temperature greater than 37.8°C
• Heart rate greater than 90 beats per minute
• Anaemia (Hb less than 105g/ L)
• Erythrocyte sedimentation rate greater than 30 mm/hour
What might you need to monitor in someone on aminosalicylates?
FBC- risk of agranulocytosis
Why would you do an x-ray in someone presenting with a flare of ulcerative colitis?
To look for toxic megacolon
What imaging would you consider doing in someone presenting with a flare of UC?
Abdominal x-ray
What are the possible causes of a flare up of UC?
stress
medications (NSAIDs, antibiotics)
cessation of smoking
What is a mild flare up of UC?
Fewer than four stools daily, with or without blood
No systemic disturbance
Normal ERS and CRP
What is classed as a moderate flare up of UC?
Four to six stools a day
Minimal systemic disturbance
What is used first in a mild to moderate flare of UC?
Topical (rectal) aminosalicylate: Azaithoprine or mesalazine
After 4 weeks if remission is not induced, what can be added to the topical aminosalicylate?
Add an oral aminosalicylate
If remission is still not induced with an topical and oral aminosalicylate what should be added?
Topical or oral steroid
What can be used to maintain remission in someone with UC?
Topical(rectal) aminosalicylate
Add oral if that isn’t sufficient
What can be added if a patient has had 2 or more flare ups in the last year?
Following a severe relapse or >=2 exacerbations in the past year
oral azathioprine or oral mercaptopurine
