Ulcerative Colitis

Question 1

CLOSEUP

Answer 1

C – Continuous inflammation

L – Limited to colon and rectum

O – Only superficial mucosa affected

S – Smoking is protective

E – Excrete blood and mucus

U – Use aminosalicylates

P – Primary Sclerosing Cholangitis

Question 2

How does UC present ?

Answer 2

Presentation
Diarrhoea
Abdominal pain
Passing blood
Weight loss

Question 3

How to test for UC?

Answer 3

-Routine bloods for anaemia, infection, thyroid, kidney and liver function
-CRP indicates inflammation and active disease
-Faecal calprotectin (released by the intestines when inflamed) is a useful screening test (> 90% sensitive and specific to IBD in adults)
-Endoscopy (OGD and colonoscopy) with biopsy is diagnostic
-Imaging with ultrasound, CT and MRI can be used to look for complications such as fistulas, abscesses and strictures.

Question 4

How to manage UC?

Answer 4

Inducing- Mild to moderate disease

First line: aminosalicylate (e.g. mesalazine oral or rectal)
Second line: corticosteroids (e.g. prednisolone)

Severe disease

First line: IV corticosteroids (e.g. hydrocortisone)
Second line: IV ciclosporin

Maintaining-
Aminosalicylate (e.g. mesalazine oral or rectal)
Azathioprine
Mercaptopurine

Surgery
Ulcerative colitis typically only affects the colon and rectum. Therefore, removing the colon and rectum (panproctocolectomy) will remove the disease. The patient is then left with either a permanent ileostomy or something called an ileo-anal anastomosis (J-pouch)