Ulcerative Colitis

Question 1

Where does inflammation in UC start and end?

Answer 1

Start: rectum
end: ileocaecal valve

Question 2

At what age is the peak incidence of UC

Answer 2

aged 15-25 years
aged 55-65 years.

Question 3

Clinical features of UC

Answer 3

bloody diarrhoea
urgency
tenesmus
abdominal pain - LLQ

Question 4

Extraintesinal symptoms of UC

Answer 4

Arthritis
Erythema nodosum
Episcleritis/uveitis
Osteoporosis
Pyoderma gangrenosum
Clubbing
Primary sclerosing cholangitis

Question 5

What factors related to UC can increase the risk of progression to colorectal cancer

Answer 5

• disease duration > 10 years
• pancolitis onset <15 years old
• unremitting disease
• poor compliance to treatment

Question 6

How often should patients with UC receive a colonoscopy to monitor for colorectal cancer?

Answer 6

Low risk - 5 yearly
Mod risk - 3 yearly
High risk - yearly

Question 7

What UC patients are considered moderate risk for development of colorectal cancer?

Answer 7

Extensive colitis with mild active inflammation

OR post-inflammatory polyps
OR FHx of colorectal cancer

Question 8

What UC patients are considered high risk of colorectal cancer?

Answer 8

Extensive colitis with severe inflammation

OR stricture in past 5 years
OR dysplasia in past 5 years declining surgery
OR PSC
OR FHx of colorectal cancer

Question 9

What factors may trigger a flare of UC?

Answer 9

stress
medications
NSAIDs
antibiotics
cessation of smoking

Question 10

Describe the difference between a mild/moderate/severe flare of UC

Answer 10

Mild - <4 bloody stools/day

Mod - 4-6 stools/day
- minimal systemic disturbance

Severe - >6 stools/day + blood
- systemic disturbance

Question 11

Treatment of mild-mod Proctitis (rectal disease only)

Answer 11

• topical (rectal) aminosalicylate
  e.g. Mesalazine
• oral aminosalicylates
  if remission is not achieved within 4 weeks
• if remission still not achieved add topical or oral steroid

Question 12

Treatment of mild-mod proctosigmoiditis and left-sided UC

Answer 12

• topical (rectal) aminosalicylate

if remission is not achieved within 4 weeks:
- oral aminosalicylate
OR
- switch to a high-dose oral aminosalicylate and a topical steroid

• if remission still not achieved
  = oral aminosalicylate and oral steroid

Question 13

Treatment of mild-mod disease spanning most of the large bowel

Answer 13

• topical (rectal) aminosalicylate + high-dose oral aminosalicylate

if remission is not achieved within 4 weeks
= high-dose oral aminosalicylate and oral steroid

Question 14

How are severe colitis flares treated?

Answer 14

IV steroids in hospital
IV ciclosporin may be used

after 72 hrs and no improvement consider surgery

Question 15

What medications can be used to manage UC after a severe relapse or if >2 exacerbations in the past year

Answer 15

oral azathioprine or oral mercaptopurine