Ulcerative Colitis Flashcards
What are the tidal factors for UC?
Genetic predisposition (HLA-B27 association)
Ethnicity - white
Family history
Episodes of previous intestinal infection
Increased fat intake
Oral contraceptive use
NSAID use
What are the different ways to classify UC?
By disease extent
By severity (look at amboss’ notes on UV for a better explanation)
What are the intestinal symptoms of UC?
Bloody diarrhoea with mucus
Fecal urgency
Abdominal pain and cramps
Tenesmus (distressing and persistent but ineffectual urge to empty the rectum or bladder)
What are the extra intestinal symptoms of UC?
General - fatigue, fever
Skeletal - osteoarthritis, ankylosis spondylitis, sacroiliitis
Ocular - uveitis, episcleritis, iritis
Biliary - primary sclerosing cholangitis
Cutaneous - erythema nodosum, pyoderma gangrenosum, aphthous stomatitis, pyostomastitis vegetans
What does chronic intermittent UC mean?
Most common course, exacerbation is followed by complete remission
What does chronic continuous mean in UC?
Complete remission doesn’t occur
Disease severity varies
What does acute fulminant mean in UC?
Sudden onset
Severe diarrhoea, dehydration and shock
Which lab tests should be done for UC?
Blood tests
Stool diagnosis to studies
Endoscopy
EGD
Abdominal X-rays
CT or MRI scans
Barium enema radiography
Abdominal US
Which blood tests should be done for UC?
CBC
ESR, CRP
Hypoalbuminemia
ALP, GGT
What will a cbc reveal in UC?
Anaemias, leukocytosis, thrombocytosis
What will ESR and CRP be like in UC?
Elevated levels may indicate active UC
What will ALP and GGT be like in UC?
Elevated in patients with concurrent PSC (primary sclerosing cholangitis)
What will stool studies show for UC?
Test for clostridioides difficile infection
What is the purpose of a PCR panel?
Check for other enteric infections
What is the purpose of a stool test if a PCR panel isn’t available?
Check for ova and parasites
What will an endoscopy show in early stages of UC?
Inflamed, erythema toes edematous mucosa
Friable mucosa with bleeding in contact with endoscope
Fibrin covered ulcers
Small mucosal ulcerations
Loss of superficial vascular pattern
what is seen on an endoscopy in chronic disease UC?
Loss of mucosal folds
Loss of haustra (outpouchings of the colon wall that give it its segmental appearance)
Strictures
Deep ulcerations
Pseudopolyps
What will an abdominal X-ray show for UC?
Normal in mild to moderate disease
In severe cases - loss of colonic haustra
May show signs of complications - toxic mega colon - massive distension
Ulceration - segmental dilation with irregular edges outlined by gas
Perforation - pneumoperiotneum
Why should you do a CT or MRI scan?
To evaluate for proximal disease involvement if endoscopy is not possible
To evaluate for complications eg bowel perforation
And for d/d with chrons disease
What findings may be present with a ct or MRI scan?
Loss of haustra
Increased bowel wall thickness
Mural hyperenhancement
Signs of complications
What will a barium enema radiography reveal in UC?
Granular appearance of the mucosa
Deep ulcerations
Loss of haustra
Pseudopolyps
What are the histological findings in UC?
Early stage - granulocyte infiltration - limited to mucosa and submucosa
Crypt abscess - infiltration of neutrophils into lime on intestinal crypts due to break down of crypt epithelium
Chronic disease - lymphocyte infiltration
Mucosal atrophy
Altered crypt architecture
Epithelial dysplasia (disordered growth of epithelium)
What is the d/d of UC?
Chron disease
Exudasrtibve inflammatory diarrhoea
Diverticular disease
Appendicitis
Ischemic colitis
Infectious colitis
Radiation colitis
Coeliac disease
Inflammatory diarrhoea
What are the complications of UC?
increased risk of cancer
Toxic megacolon
Fulminant colitis
What is the treatment for mild to moderate UC?
First line treatment - Mesalamine
Corticosteroids may be added in patients who do not tolerate mesalamine therapy
What is the treatment for moderate to severe UC?
Oral corticosteroids or anti TNF therapy with or without azathioprine
Or integrity receptor antagonist
Or JAK3 inhibitor
What is the treatment for acute severe UC?
IV corticosteroids
Consider cyclosporine or infliximab for patients who do not achieve remission after 3-5 days off systemic corticosteroids
What type of supportive therapy should be given for UC?
Treat pain as needed eg heat pads or sedatives
Avoid parenteral nutrition unless required to improve nutritional status prior to colectomy
Identify and treat any micronutrient deficiency
