Ulcerative Colitis

Question 1

What is UC?

Answer 1

• UC is the most common Inflammatory Bowel Disease

Question 2

What Histology is seen in UC?

Answer 2

• Non-granulomatous inflammation with Crypt Abscess formation

Question 3

What is the Pathophysiology of UC?

Answer 3

• Genetic Factors
• Environmental Triggers

Question 4

What are the features of UC?

Answer 4

• Diffuse continuous mucosal inflammation involving the large bowel typically starting at the rectum
• Part of the small bowel can be affected the distal ileum, known as “backwash ileitis”
• non-granulomatous inflammation forming crypt abscesses and goblet cell hypoplasia
• pseudopolyps: repeated cycles of ulceration and healing leading to raised areas of inflamed tissues

Question 5

What are the Clinical Features of Crohn’s?

Answer 5

• Bloody diarrhoea
• Proctitis (inflammation of the rectum)
• PR bleeding and mucus discharge
• Frequency and urgency of defecation (up to 6 times a day) and tenesmus
• Systemic Symptoms: Malaise, Anorexia and low-grade pyrexia

Question 6

What investigations would you do for UC?

Answer 6

• Routine Bloods: FBC, U+E, CRP, LFTs (Anaemia and Low Albumin)
• Stool Sample: Faecal Calprotectin
• Imaging:
  GOLD STANDARD: Colonoscopy with biopsy
• CT Abdo/pelvis
• AXR - mural thickening + thumbprinting + lead-pipe colon

Question 7

What Managment would you do for UC for Inducing Remission?

Answer 7

1.Fluid Resuscitation
2. Nutritional Support
3. Prophylactic Heparin
4. IV hydrocortisone
5. immunosuppressive agents: ciclosporin + 5-ASA
6. Biological Agents: Infliximab

Question 8

What management would you do for UC to Maintain Remission?

Answer 8

• Immunomodulators such as 5-ASA (mesalazine, sulfasalazine)
• Colonoscopic Surveillance is offered to people who have had the disease
• IBD- nurse specialists required
• Enteral Nutritional Support

Question 9

What Surgical Managment should be done for UC?

Answer 9

• Total Proctocolectomy is curative with an end ileostomy
• Subtotal Colectomy with ileo-rectal anastomosis
• Panproctocolectomy with ileo-pouch anal anastomosis

Question 10

What are the complications of UC?

Answer 10

• Toxic Megacolon (abdo pain, abdo distention, pyrexia and systemic toxicity - decompression due to perforation)
• Colorectal Carcinoma
• Osteoporosis (regular assessment for fracture risk)
• Pouchitis ( inflammation of the ileal pouch = abdo pain and bloody diarrhoea, treated with metronidazole and ciprofloxacin)