Ulcerative colitis Flashcards
IN MINDMAPS FOR MEDICINE
yes
Where is UC?
Confined to colon- worst within rectum
Where is inflamamtion inv crohns?
Confined mycosa + submucosa
Histology UC
Crypt abscesses, mucosal ulcers and depleted goblet cells, increased inflammatory cells
UC x ray
Thumb printing
Thickening of haustral folds
Often acute inflammation
UC pathology
- Superficial inflammation
- Lymphoid aggregates and plasma cells
- Bifid crypts - abscess formation
- Crypt distance increases
- loss absorptive surfaces
- Psurdopolyps (non absorptive)- epithelial regenration
- Vascular oedema and bleeding
UC symptoms
- Cramping pain - LLQ esp
- Blood
- Muscous
- Tenesmus + urgenyc
- Classically diarrhoea (bloody)
What is the true love and witts severity index?
Rates severity og ulcerative colitis
What is severe UC on true love and witts severity index?
65+
What does a score of 35-64 mean on true love and witts severity index
moderate disease
What is mild disease true love and witts severity index for UC?
10-34
When is UC in remission on true love and witts severity index?
Under 10
What are the features of true love and witts severity index?
Bowel movements
Blood in stools
Pyrexia (37.8 degreees)
Pulse over 90BPM
Anaemia
ESR
Mayo endosocopic grading score 1 UC
Midl disease
Erythema, decreased vascular pattern, mild friability
Mayo UC endoscopic score 2
Marked erythema, absent vascular pattern, friability, erosions
Mayo UC endoscopic score 3
Severe disease
Spontaneous bleeding, ulcerations
Causes of UC
- Infective - enteric, STIs, viral, amoebic
- Immunological - typhilitis
- Diverticulae
- Microscopic
- Medications
- Radiation
Manage IBD flare
- IV steriods
- +/- ciclosporin/infliximab - immunosupression,
- Optimise - Hb, fluids, infection, nutrition, VTE
- Gastroenterology
- Surgeons - colectomy
Severe treatment of UC
- Biologicals
- Janus kinase inhibitors
- Infliximab/adalimubab - moncolonal TNF alpha
- Vedolizumab
What is proctitis?
Inflammation of the lining of the rectum
Ischaemic colitis risk factors
- Vasculopathies - stroke and heart attack risk also risk ischaemic bowel
- Coagulopathic
- Aneurysmal surgery
- Hypotension
- Mesenteric angina - post prandial
- Mucosa is first thing to die - shed into stool
Symptoms of diverticular disease
- Blood
- Constipation/haemorrhoids
- Sigmoid involvement, normal mucose
- Self limitng - weeks, months
What is diverticular UC?
Pouches in bowel wall - heavy strain
Pockets collect faecal matter → inflamamtion and bleeding
Causes of diverticular UC
- Meds
- Radiation
- Microscopic
UC on X ray
Thumb printing
Thickened haustral folds
Acute inflamamtion
Large bowel continious
What meds cause UC
MMF - kindey or liver transplant treated, 1/3 get colitis
NSAID induced colitis
NSAID flares of IBD
Cocaine - smuggling → colitis - stimulant → vasoconstriction ⇒ ischaemic colitis
What does radiation cause? How long before can cause?
3 weeks to years
- Chronic ischaemia, fibrosis, friable, enarteritis
- Bleeds, strictures
When escalate IBD management
Escalate if > 2 flares a year
What is ciclosporin
- Ciclospin - clainerin inhibitor - T cell
L sided colitis vs pancolitis
L sided does not expand beyond spleniic flexure, pancolitis does
What is curatice for UC?
Colectomy
Extraintestinal symptoms of UC? skin, eye, joints, bones, liver
Erythema nodosum, pyoderma gangronosum
Aphtlous ulcers
Episcleritis, ant uveitis
Arthritis - asymmetric, pauarticular
Sacrolitis, ank spond
Osteoporosis
Clubbibng
Primary scleroisng cholangitis
What is mild disease parameters for each section Ture love and witts UC?
<4 stools a day
Small amounts bloody stool
NO anaemia, fever, normal ESR/CRP, pulse <90
What is severe UC on true love and witts criteria?
> 6 stoos a day
Visible bloood in stool
At least one systemic upset 0 temp . 37.8, hr > 90, esr > 30
Complications of UC
Psychological
Toxic megacolon
Colorectal cancer
VTE
Osteoporosis
WHy do you get osteoporosis in UC?
Steroid use
Ass conditions w UC
Turners syndorme
Wiskott Aldrich
Glycogen storage
IL-10 deficiency (refactory IBD)
Primary scleroisng cholangitis
What is Wiskott aldrich?
X recessive syndrome -> imunodeficiency + thrombocytopenia
What is Primary scleroisng cholangitis
Bile duct fibrosis
Autoimmune
-> encephalopathy unless liver transplant
What gene is ass with IBD?
CARD 15 - crohns
2/3 - HLA B 27 - ank spond
What bacteria increases risk of UC
- Salmonella, shingella, campylobacter, Cdiff S
1st line treatment UC
5 ASAs - rectal topical or steroids
eg rectal mesalazine, oral 5 ASAs
When is oral prednisolone used in UC?
2nd line for patients who fail to repsond to aminosalicyclates
Maintatining remission
Oral 5 ASA=s
Azathioprine/mercaptopurine
pROBIOTICS
bARIUM enema UC what see
Loss of haustrations, superficial ulceration, psurdopolyps, drainpipe colon 0 narrow and short
1st line investigation for diagnosing UC
Colonsocopy with biopsies
What is lactoferrin?
Granulocyte iron binding glycoprotein found in stool
