Ulcerative Colitis

Question 1

What are the tidal factors for UC?

Answer 1

Genetic predisposition (HLA-B27 association)
Ethnicity - white
Family history
Episodes of previous intestinal infection
Increased fat intake
Oral contraceptive use
NSAID use

Question 2

What are the different ways to classify UC?

Answer 2

By disease extent
By severity (look at amboss’ notes on UV for a better explanation)

Question 3

What are the intestinal symptoms of UC?

Answer 3

Bloody diarrhoea with mucus
Fecal urgency
Abdominal pain and cramps
Tenesmus (distressing and persistent but ineffectual urge to empty the rectum or bladder)

Question 4

What are the extra intestinal symptoms of UC?

Answer 4

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

Question 5

What does chronic intermittent UC mean?

Answer 5

Most common course, exacerbation is followed by complete remission

Question 6

What does chronic continuous mean in UC?

Answer 6

Complete remission doesn’t occur
Disease severity varies

Question 7

What does acute fulminant mean in UC?

Answer 7

Sudden onset
Severe diarrhoea, dehydration and shock

Question 8

Which lab tests should be done for UC?

Answer 8

Blood tests
Stool diagnosis to studies
Endoscopy
EGD
Abdominal X-rays
CT or MRI scans
Barium enema radiography
Abdominal US

Question 9

Which blood tests should be done for UC?

Answer 9

CBC
ESR, CRP
Hypoalbuminemia
ALP, GGT

Question 10

What will a cbc reveal in UC?

Answer 10

Anaemias, leukocytosis, thrombocytosis

Question 11

What will ESR and CRP be like in UC?

Answer 11

Elevated levels may indicate active UC

Question 12

What will ALP and GGT be like in UC?

Answer 12

Elevated in patients with concurrent PSC (primary sclerosing cholangitis)

Question 13

What will stool studies show for UC?

Answer 13

Test for clostridioides difficile infection

Question 14

What is the purpose of a PCR panel?

Answer 14

Check for other enteric infections

Question 15

What is the purpose of a stool test if a PCR panel isn’t available?

Answer 15

Check for ova and parasites

Question 16

What will an endoscopy show in early stages of UC?

Answer 16

Inflamed, erythema toes edematous mucosa
Friable mucosa with bleeding in contact with endoscope
Fibrin covered ulcers
Small mucosal ulcerations
Loss of superficial vascular pattern

Question 17

what is seen on an endoscopy in chronic disease UC?

Answer 17

Loss of mucosal folds
Loss of haustra (outpouchings of the colon wall that give it its segmental appearance)
Strictures
Deep ulcerations
Pseudopolyps

Question 18

What will an abdominal X-ray show for UC?

Answer 18

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

Question 19

Why should you do a CT or MRI scan?

Answer 19

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

Question 20

What findings may be present with a ct or MRI scan?

Answer 20

Loss of haustra
Increased bowel wall thickness
Mural hyperenhancement
Signs of complications

Question 21

What will a barium enema radiography reveal in UC?

Answer 21

Granular appearance of the mucosa
Deep ulcerations
Loss of haustra
Pseudopolyps

Question 22

What are the histological findings in UC?

Answer 22

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)

Question 23

What is the d/d of UC?

Answer 23

Chron disease
Exudasrtibve inflammatory diarrhoea
Diverticular disease
Appendicitis
Ischemic colitis
Infectious colitis
Radiation colitis
Coeliac disease
Inflammatory diarrhoea

Question 24

What are the complications of UC?

Answer 24

increased risk of cancer
Toxic megacolon
Fulminant colitis

Question 25

What is the treatment for mild to moderate UC?

Answer 25

First line treatment - Mesalamine
Corticosteroids may be added in patients who do not tolerate mesalamine therapy

Question 26

What is the treatment for moderate to severe UC?

Answer 26

Oral corticosteroids or anti TNF therapy with or without azathioprine
Or integrity receptor antagonist
Or JAK3 inhibitor

Question 27

What is the treatment for acute severe UC?

Answer 27

IV corticosteroids
Consider cyclosporine or infliximab for patients who do not achieve remission after 3-5 days off systemic corticosteroids

Question 28

What type of supportive therapy should be given for UC?

Answer 28

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