Ulcerative colitis Flashcards
What is ulcerative colitis?
This is an inflammatory disorder of the colon and rectum
Who is most at risk of ulcerative colitis?
Young males
Peak in 30s
Describe the pathophysiology of ulcerative colitis?
The disease starts in the rectum and moves continuously and proximally, but is confined to the colon
What are some symptoms of ulcerative colitis?
Diarrhoea
Mucus PR
Bleeding PR
Urgency
Tenesmus
Night rising
LIF pain
Proximal constipation
How can ulcerative colitis present on the skin?
Pyoderma gangrenosum
Erythema nod-sum
What are some extra-intestinal manifestations of ulcerative colitis?
Arthritis
Ankylosing spondylitis
Uveitis
Oxalate renal stones
What investigations are required in ulcerative colitis?
Bloods
Abdominal x-ray
Colonoscopy and biopsy
What blood test findings are expected in ulcerative colitis?
Raised CRP
Low albumin
Faecal calprotectin positive
What can be seen on AXR in ulcerative colitis?
Stool absent from inflamed colon
Mucosal oedema shows thumb-printing
What will be seen on colonscopy in ulcerative colitis?
Inflammation and erythema extending proximally from the anal margin
Mucosal ulceratio
Pseudo-polyps
Describe the histology of the colon wall in ulcerative colitis
Absence of goblet cells
Crypt distortion and abscesses
Mucosal layer only affected
Infiltration of monocytes/neutrophils and plasma cells
What is the Truelove and Witt criteria for severity of ulcerative colitis?
> 6 bloody stools/24 hours
As well as one of the following:
- Fever >37.8ºC
- Tachycardia >90/min
- Anaemia (Hb < 10.5 g/dL)
What is CLOSE UP in ulcerative colitis?
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 aminosalycilates
P - Primary sclerosis cholangitis
Describe the pattern of disease in UC
Pattern of exacerbation and remission, with continuous, low grade activity
What is meant by toxic megacolon?
This is a single attack of ulcerative colitis, leading to complete paralysis and massive dilatation, to >6cm, which can cause rupture
What conditions can cause toxic megacolon?
Ulcerative colitis
Clostridioides difficile infection
What are some symptoms of toxic megacolon?
- Abdominal pain
- Bloating
- Can induce tachycardia and shock
- Fever
What is the treatment option for toxic megacolon?
Urgent decompression
What is meant by pan-colitis?
Inflammation of the whole colon
What is meant by proctitis?
Inflammation of the rectum
How are flare ups of ulcerative colitis classed in terms of severity?
Mild - < 4 stools/day, small amount of blood
Moderate - 4-6 stools/day, varying amounts of blood, no systemic upset
Severe - >6 bloody stools per day + features of systemic upset (pyrexia, tachycardia, anaemia, raised inflammatory markers)
What are some complications of ulcerative colitis?
Toxic megacolon
Increased risk of colorectal carcinoma
Blood loss - Anaemia
Hypokalaemia
Primary sclerosis cholangitis
What are some surgical options available in ulcerative colitis?
Complete proctocolectomy and permanent ileostomy
Restorative proctocolectomy and J pouch
Subtotal colectomy with ileostomy
How are mild, not hospitalised flare ups of ulcerative colitis treated?
1st - Rectal aminosalicylates (Oral if not cleared in 4 weeks)
2nd - Oral corticosteroids: Prednisolone, budesonide
