Ulcerative Colitis* Flashcards
What is UC
Chronic Inflammatory granulomatous disease that affects the Colon only (Rectum to sigmoid to proximal colon)
Is UC more common than Crohn’s
Yes
What are the symptoms of UC
Blood-Mucus diarrhoea
LLQ pain
Weight loss and fever
Tenesmus (Defecation pain)
What are the signs of UC
Post rectal bleeding = Anaemia
Tender Abdomen
Blood-Mucus on PR exam
What are the extra-intestinal features of UC
DERM = Erythema Nodosum and Pyoderma Gangrenosum EYE = Uveitis, Episcleritis and Conjunctivitis MSK = Clubbing, Arthritis and Sacroilitis Liver = Billiary Carcinoma, Primary Sclerosing Cholengitis (Common in UC>Crohn's)
What are the investigations for UC
Positive pANCA
Raised Faecal Calcoprotein (IBD)
Colonoscopy = Continuous Inflammation and Lead pipe sign
Biopsy = Mucosal Inflammation and Crypt Hyperplasia
Barium Enema (CI in acute)
Truelove and Witts Criteria (For flares)
Which UC endoscopic imaging are contraindicated in the Acute setting of UC
Barium enema
Colonoscopy
-Risk of bowel perforation
Which investigation is preferred in Acute UC
CT imaging
What are the Endoscopic investigations for UC
Colonoscopy
(Continuous Inflammation and Lead Pipe sign)
Biopsy
(Loss of goblet cells, Crypt Hyperplasia and Lymphocytes)
Barium Enema
(Lead piping Inflammation, thumb prints and pseudo polyps)
What is the severity criteria used for acute UC
Truelove and Witts
What is the difference in bowel movement and stool blood in the TL and W criteria
Mild. Moderate Severe
Bowel. <4. 4-6. 6+
Blood. Little Moderate Visible
Truelove and Witts criteria is the same for other factors for mild and moderate in Pyrexia, Tachypnoea, Anaemia and ESR. How is it different in Severe
There is - Pyrexia - Tachypnoea - Anaemia and the ESR IS OVER 30
What is the treatment for mild and moderate UC
Mild = Induce remission (4 Weeks)
Moderate
-Topical/Oral SULFASALAZINE
-Add PREDNISOLONE if not better
Give three types of ASA “ALAZINE”
Sulfasalazine
Mesalazine
Olsalazine
What is the treatment for Severe UC
IV Corticosteroids
Add IV Ciclosporin/infliximab if not better
When is Colectomy indicated in UC
Acute fulfilment UC
Toxic Megacolon
Worse symptoms with IV steroids
What are the surgical options for UC
Colectomy with temp ileostomy (Stoma bag)
Panprocto-colectomy with perm ileostomy
What is a toxic megacolon
Severe colitis where UC is not causing bowel movement
-Diagnose with Xray
What is the long term complication of UC
COLERECTAL CANCER
What are the short term complications of UC
Primary sclerosis Cholengitis
Cholangiocarcinoma
Inflammatory Pseudopolyps
What is the most likely risk factor for UC
First degree relative
-Increase risk by 7x
What can long term use of Sulfasalzine(ASA) cause
Acute pancreatitis
-Raised blood amylase
What are the genetic associations with UC
HLAB27
pANCA Positive
Where does UC affect in the GI Tract
Colon
-Rectum to Sigmoid to Proximal colon
Where is the inflammation found in UC
Confined to the mucosa
What can be given for remission of UC
Azathioprine
Methotreaxate
Cyclosporin
