Ulcerative Colitis

Question 1

what is ulcerative colitis?

Answer 1

continuous submucosal and mucosal inflammation of the rectum that progresses up the large intestine

Question 2

who is most likely to get UC? (epi)

Answer 2

FH of UC/IBD in general
caucaians
equal females and males

Question 3

At what age are we expecting pts to first present with UC?

Answer 3

has a bimodial pattern of incidence
mostly dianogsed in younger pop ➔ 15-30yrs

but can be in older as well 50-70yrs

Question 4

how the prognosis for UC?

Answer 4

good prognosis, most pts go into remission

Question 5

what factors contribute to the development of UC?

Answer 5

not fully elucidated
combination of genetics, environment, and dysfunctional immune response
- primarily genetic tho!
- there is evidence of autoimmunity as a part of UC pathophys
- also some evidence that gut microbiota can contribute to the UC

UC does NOT require an external trigger that CD needs to be triggered

Question 6

what is the pathophys of developing UC?

Answer 6

ALWAYS STARTS IN THE RECTUM
- a combo of a defect in the epithelial barrier, immune response, and the microflora of the colon

1. starts in the rectum
   defect in the epithelial barrier
2. increased uptake of luminal antigens
   - with poor microflora, the immune system may be more sensitive to non-pathogenic bacteria
3. increased activated immune cells
4. damaged epithelial cells
5. ulceration
6. progresses up towards the large intestine

Question 7

what is the hallmark s/s of UC? (1 s/s)

Answer 7

attacks of bloody diarrhea with or without mucus, interspersed with asymptomatic intervals

Question 8

What type of pt picture would align with s/s of UC?

Answer 8

1. attacks of blood diarrhea +/- mucus
2. increased urgency to defecate
3. tenesmus - urge to defecate even when there’s nothing to defecate
4. LLQ pain – the rectum/descending colon area
5. wt loss

Question 9

What can exacerbate UC?

Answer 9

NSAID use

Question 10

does UC usually have extraintestinal manifestation? yes or no? and if yes, what?

Answer 10

yes

same as CD
➔ eyes, bones, skin, biliary/liver, renal

Question 11

what sort of cx are we on the look out for with UC?

Answer 11

1. toxic megacolon
2. Primary sclerosing cholangitis - primary disease of the bile ducts
3. colon cancer
4. VTE

Question 12

What is the diagnostic test for UC? what would you see?

Answer 12

colonoscopy ➔ continuous inflammation/ulceration from the rectum up the large intestine
- may also see pseudopolyps

Question 13

what other ix would you consider when working up a potential UC patient?

Answer 13

1. Carcinoembryonic antigen (CEA) ➔ will be elevated in a flare of UC
2. fecal calprotectin ➔ non specific but will tell you there is inflammation in the intestines ➔ rules in an IBD
3. stool O&P ➔ r/o infectious parasites as cause for diarrhea
4. anything else that is done for Crohn’s

Question 14

what is the Montreal classification system for UC?

Answer 14

E: extent of disease determined by endoscopic evaluation
- E1: proctitis ➔ rectum and anus
- E2: L-sided or distal colitis ➔ rectum, sigmoid colon, and descending colon
- E3: pancolitis ➔ rectum, whole colon

S: severity determined by s/s and systemic findings
- S0: remission
- S1: mild
- S2: moderate
- S3: severe

Question 15

How would you medically manage ulcerative colitis pts in remission?

Answer 15

remission pts
1. consider topical rectal 5-ASA for pts w/mild proctitis disease
2. consider oral 5-ASA for L-sided colitis
3. add biologics or immunomodulator as disease gets more severe to keep disease in remission

Question 16

How would you medically manage ulcerative colitis pts in acute phases?

Answer 16

1. admit to ICU
2. secure IV access
3. IV corticosteroid
4. supportive
5. consider surgery to remove affected area esp if pt not tolerating medicine and s/s aren’t getting better
6. also consider abx for potential perforation or bacterial infection from colitis

if not too severe requiring surgery, can consider 5-ASA, biologics, and immunomodulators