Ulcerative colitis Flashcards
1
Q
Sx of UC
A
- chronic frequent diarrhoea +- blood/mucus
- diffuse intermittent abdominal pain
- systemic sx: fever, malaise, anorexia, weight loss
- affect GIT distal to ileum (if ileum if affected = backwash ileitis); mostly rectum (proctitis), L) colon, entire colon
- no skip lesion
2
Q
Signs on UC on examination
A
maybe none.
In acute,
- fever
- tachycardia
- tender and distended abdomen
Extra-intestinal signs
1) erythema nodosum
2) arthritis (HLA B27)
3) conjunctivitis, iritis, episcleritis
4) clubbing
3
Q
Risk factors for UC
A
- non smoker are at 3 fold risk
- some genetic susceptibility
- unknown cause
4
Q
Investigation for UC
A
Blood - FBE, CRP, ESR, U&E, LFT, blood culture
Stool MC&S - exclude campylobacter, C. difficile, Salmonella, Shigella, E. coli, amoebae
AXR - no faecal shadow, thicken mucosal lining
erect CXR - look for perforation
Ba enema - NEVER do this during severe attack or for diagnostic; look for ulcer + loss of haustra pattern
Colonoscopy - disease extent and biopsy
- inflammatory infiltrate - goblet cell depletion - glandular distortion - mucosal ulcer - crypt abscess
5
Q
Management for UC
A
induce remission with
- steroids - prednisolone PO + hydrocortisone foam PR
wean off steroid slowly if improved
for severe UC (unwell & > 6 motions/day)
- admit for NBM
- IV hydration
- steroid PO and PR
- monitor - T, BP, P, stool freq & character
- if steroid doesn’t work, consider immunomodulation
- surgery is needed at some stage in 20% - proctocolectomy + terminal ileostomy
(indications: perforation, massive haemorrhage, megacolon, failed medical therapy)
6
Q
Complications of UC
A
perforation and bleeding !!!
- toxic dilation of colon (megacolon) -> perforation
- venous thrombosis (UC -> hypercoagulation)
- colonic ca -> colonoscopy for surveillence
