Ulcerative Colitis*

Question 1

What is UC

Answer 1

Chronic Inflammatory granulomatous disease that affects the Colon only (Rectum to sigmoid to proximal colon)

Question 2

Is UC more common than Crohn’s

Answer 2

Yes

Question 3

What are the symptoms of UC

Answer 3

Blood-Mucus diarrhoea
LLQ pain
Weight loss and fever
Tenesmus (Defecation pain)

Question 4

What are the signs of UC

Answer 4

Post rectal bleeding = Anaemia
Tender Abdomen
Blood-Mucus on PR exam

Question 5

What are the extra-intestinal features of UC

Answer 5

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)

Question 6

What are the investigations for UC

Answer 6

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)

Question 7

Which UC endoscopic imaging are contraindicated in the Acute setting of UC

Answer 7

Barium enema
Colonoscopy
-Risk of bowel perforation

Question 8

Which investigation is preferred in Acute UC

Answer 8

CT imaging

Question 9

What are the Endoscopic investigations for UC

Answer 9

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)

Question 10

What is the severity criteria used for acute UC

Answer 10

Truelove and Witts

Question 11

What is the difference in bowel movement and stool blood in the TL and W criteria

Answer 11

Mild. Moderate Severe
Bowel. <4. 4-6. 6+
Blood. Little Moderate Visible

Question 12

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

Answer 12

There is
- Pyrexia
- Tachypnoea
- Anaemia
and the ESR IS OVER 30

Question 13

What is the treatment for mild and moderate UC

Answer 13

Mild = Induce remission (4 Weeks)
Moderate
-Topical/Oral SULFASALAZINE
-Add PREDNISOLONE if not better

Question 14

Give three types of ASA “ALAZINE”

Answer 14

Sulfasalazine
Mesalazine
Olsalazine

Question 15

What is the treatment for Severe UC

Answer 15

IV Corticosteroids

Add IV Ciclosporin/infliximab if not better

Question 16

When is Colectomy indicated in UC

Answer 16

Acute fulfilment UC
Toxic Megacolon
Worse symptoms with IV steroids

Question 17

What are the surgical options for UC

Answer 17

Colectomy with temp ileostomy (Stoma bag)

Panprocto-colectomy with perm ileostomy

Question 18

What is a toxic megacolon

Answer 18

Severe colitis where UC is not causing bowel movement

-Diagnose with Xray

Question 19

What is the long term complication of UC

Answer 19

COLERECTAL CANCER

Question 20

What are the short term complications of UC

Answer 20

Primary sclerosis Cholengitis
Cholangiocarcinoma
Inflammatory Pseudopolyps

Question 21

What is the most likely risk factor for UC

Answer 21

First degree relative

-Increase risk by 7x

Question 22

What can long term use of Sulfasalzine(ASA) cause

Answer 22

Acute pancreatitis

-Raised blood amylase

Question 23

What are the genetic associations with UC

Answer 23

HLAB27

pANCA Positive

Question 24

Where does UC affect in the GI Tract

Answer 24

Colon

-Rectum to Sigmoid to Proximal colon

Question 25

Where is the inflammation found in UC

Answer 25

Confined to the mucosa

Question 26

What can be given for remission of UC

Answer 26

Azathioprine
Methotreaxate
Cyclosporin