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General surgery + HPB - YR3 > Ulcerative Colitis > Flashcards

Ulcerative Colitis Flashcards

1
Q

Peak age incidence for UC

A

15-40yrs old
Incidence in people >60 is increasing though

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2
Q

Pathophysiology of UC

A
  • Environmental exposures
  • Genetic predisposition
  • Dysregulated immune response
  • Dysbiosis - altered gut microbiota
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3
Q

Histological changes UC

A
  • Non-granulomatous inflammation - submucosa and mucosa
  • Crypt abscesses
  • Goblet cell hypoplasia
  • Can get pseudopolyps from repeated cycles of ulceration and healing - raised areas
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4
Q

Smoking UC

A

Protective role - unlike in Crohns

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5
Q

Symptoms of UC

A
  • Most common - proctitis
  • Inflammation confined to rectum
  • Bloody diarrhoea
  • Others inc mucus discharge PR, increased stool freq and urgency, tenesmus
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6
Q

If widespread colonic involvement, what are some additional symptoms?

A
  • Dehydration
  • Systemic symptoms eg malaise, anorexia, low grade pyrexia
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7
Q

Disease grading for UC

A
  • Truelove and Witt criteria
  • Based on bowel movements, blood in stool, pyrexia, pulse, anaemia, ESR
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8
Q

Extra-intestinal manifestations of UC

A

SAME AS CROHNS - recall list of MSK, skin, eyes, hepatobiliary
But no renal

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9
Q

Investigations UC - bloods and bedside

A
  • Same as Crohns
  • Bloods- FBC, LFT (albumin), CRP
  • Faecal calprotectin
  • Stool MC&S
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10
Q

Imaging for UC

A
  • Colonoscopy with biopsy = most sensitive and specific tool for diagnosis
  • Acute flare - urgent CT - check for obstruction, toxic megacolon or perforation
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11
Q

Endoscopic findings of mild and then moderate/severe UC

A
  • Clear demarcation where inflammation ends
  • Erythema
  • Vascular congestion

If more severe:
* Loss of vascular patterns
* Mucosal friability
* Ulcers
* Pseudopolyps

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12
Q

Scoring system for extent and severity of UC

A
  • Extent - Montreal score
  • Severity - Mayo score
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13
Q

AXR signs of acute flare UC

A
  • Mural thickening
  • Thumb printing sign (wall oedema)
  • Lead pipe colon if severe, chronic case - muscularis mucosae hypertrophy
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14
Q

General management UC

A
  • Same as Crohns
  • Refer to gastro
  • IBD MDT input
  • IBD nurse specialists
  • Consider enteral nutrition and low fibre diets
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15
Q

Surveillance for UC

A
  • Same as Crohns
  • Endoscopic surveillance for colorectal cancer
  • If had disease more than 10 years and more than 1 segment of bowel affected
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16
Q

Medical management - mild to moderate UC

A
  • Mesalazine for inducing remission and maintanance
  • Can be suppository for proctitis or orally if left sided/extensive colitis
  • If not responding to mesalazine, try corticosteroids
17
Q

Moderate to severe disease UC management

A
  • Corticosteroids
  • If improve, biologics eg anti TNF (infliximab) or vedolizumab or thiopurines (azathiopruine) can be used for maintenance
18
Q

Management of acute flare of UC

A
  • Admission usually
  • IV corticosteroids
  • If these fail - ciclosporin or inflximab therapy - surgery if not improved after 4-7 days
  • Fluids
  • Prophylactic heparin + antiembolic stockings - prothrombotic state
19
Q

Surgical management UC indications

A
  • Emergency - toxic megacolon, colonic perforation uncontrolled bleeding
  • Elective - medically refractory disease, medication intolerance, colorectal cancer (or endoscopically irresectable dysplasia)
20
Q

Emergency surgery often done for UC

A
  • Segmental or subtotal colectomy with stoma formation
  • Subtotal is whole colon gone but leave rectum and anus
  • Segmental is portion of colon removed
21
Q

Elective operation choice often

A
  • Proctocolectomy and ileal pouch anal anastomosis - esp if keen to avoid stoma
  • Often done staged approach - 3 stages, allows recovery between procedures and reduces patient morbidity
  • Other option is proctocolectomy with end ileostomy
22
Q

3 stages of proctocolectomy and ileal-pouch anal anastomosis

A
  1. Subtotal colectomy with end ileostomy
  2. Completion proctectomy and ileal-pouch anal anastomosis formation with temporary loop ileostomy
  3. Ileostomy reversal
23
Q

Complications of UC

A
  • Toxic megacolon
  • Colorectal adenocarcinoma
  • Pouchitis - inflammation if ileal pouch if undergone an IPAA
24
Q

Presentation and management toxic megacolon

A
  • Abdominal pain, distension, pyrexia and systemic upset
  • Decompression of bowel - high risk of perforation, failure to respond to medical therapy = indication for surgery (NBM and NG tube)
25
Q

Presentation and management pouchitis

A
  • Bloody diarrhoea and abdominal pain
  • Metronidazole and ciprofloxacin
26
Q
A

General surgery + HPB - YR3 (38 decks)

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