Ulcerative Colitis Flashcards
what is anterior uveitis?
inflammation of the anterior portion of the uvea, which includes the iris and ciliary body
how do patients with anterior uveitis present?
- red and painful eye
- photophobia
- blurred vision
- lacrimation
- hypopyon (inflammatory cells in the anterior chamber)
what conditions are anterior uveitis associated with?
HLA-B27
what are the clinical features of cholangiocarcinoma?
- upper abdominal discomfort
- itching
- jaundice
- afebrile
- non-tender mass palpable in the RUQ
what is the tumour marker for cholangiocarcinoma?
C 19-9 (also elevated in pancreatic cancer and gastric cancer)
what other conditions is UC associated with?
- erythema nodosum
- pyoderma gangrenosum
- uveitis
- scleritis
- episcleritis
- primary sclerosing cholangitis (PSC)
what is a cholangiocarcinoma?
biliary tract malignancy
what is ulcerative colitis?
chronic-relapsing-remitting inflammatory granulomatous disease affecting the large bowel
what are the acute complications of UC?
- toxic megacolon
- massive lower GI haemorrhage
what is the management of toxic megacolon?
- IV fluids + IV hydrocortisone
- failure to respond to IV steroids within 48-72 hours is an indication for surgery
what resource is used to assess severity of UC?
truelove and witts severity index
what is mild UC on truelove and witt’s criteria?
- bowel movements = <4
- blood in stools = small amounts
- pyrexia = no
- pulse >90 = no
- anaemia = no
- erythrocyte sedimentation = <30
what is moderate UC on truelove and witt’s criteria?
- bowel movements = 4-6
- blood in stools = mild amounts
- pyrexia = no
- pulse >90 = no
- anaemia = no
- erythrocyte sedimentation = <30
what is severe UC on truelove and witt’s criteria?
- bowel movements = >6 + systemic upset
- blood in stools = visible blood
- pyrexia = yes
- pulse >90 = yes
- anaemia = yes
- erythrocyte sedimentation = >30
what ages does UC typically present at?
15-25 and 55-65 years
what are the symptoms of UC?
- diarrhoea containing blood/mucous
- tenesmus or urgency
- pain in the left iliac fossa
- systemic symptoms - weight loss, fever
what non-radiological investigations should be carried out in UC?
- blood tests - FBC, ESR/CRP, LFTs
- microbiology - to exclude infective colitis
- faecal calprotectin - useful way to distinguish between IBS and IBD
what will be see on colonscopy in UC?
- continuous inflammation with an erythematous mucosa
- loss of haustral markings
- pseudopolps
what will be seen on biopsy in UC?
- goblet cells
- crypt abscess
- inflammatory cells (predominantly lymphocytes)
what will a barium enema find in UC?
- lead-piping inflammation - secondary to loss of haustral markings
- thumb-printing (marker of bowel inflammation)
- pseudopolyps - due to areas of ulcerating mucosa adjacent to areas of regenerating mucosa
what images are contraindicated in the acute setting?
colonscopy and barium enema due to risk of perforation
what imaging should be carried out in an acute setting?
- CT
- abdominal x-ray
- erect chest x-ray
what is the management of mild/moderate UC?
- topical aminosalicylate (ASA) or oral ASA
- oral prednisolone if no improvement within 4 weeks
- oral tacrolimus if no improvement after 2-4 weeks
proctitis and proctosigmoiditis
what is the management of left-sided or extensive disease?
high dose oral aminosalicylate
what is the medical management of severe UC?
- IV corticosteroids
- IV ciclosporin if no improvement in 72 hours
what are the indications for emergency surgery?
- acute fulminant UC
- toxic megacolon with no improvement after 48-72 hours of IV steroids
- symptoms worsening despite IV steroids
what is the surgical management of UC?
- panproctocolectomy with permanent end ilestomy
- colectomy with temporary end ileostomy
what are the indications for elective surgery?
failure to induce remission by medical means
what are the long-term complications of UC?
- colorectal cancer
- cholangiocarcinoma
- colonic strictures
what is the diagnostic criteria for toxic megacolon?
radiographic evidence of colonic dilatation >6cm + 3 of:
* temperature >38
* heart rate >120bpm
* neutrophilic leucocytosis
* anaemia
+1 of:
* dehydration
* altered consciousness
* electrolyte disturbance
* hypotension
