Ulcerative Colitis

Question 1

Features on Hx for UC

Answer 1

1) Frequent (>20/ day) runny stools + small volumes
2) Can be episodic or chronic
3) +/- blood and mucous–> mixed in with stools (may have frank blood on PR)
4) No change in stool colour
5) Can have urgency + Tenesmus
6) Crampy abdo pain (LLQ)
7) Mild fever
8) LOW, LOA
NO N+V, GORD or DYSPHAGIA

Question 2

RFs for UC

Answer 2

1) FHx
2) NSAIDs

Smoking is protective

Question 3

Features on P/E for UC

Answer 3

1) Abdo exam: doesn’t reveal much–> may have some distention or tenderness if toxic megacolon
2) PR: red inflamed anus, anal fissures, may be painful on exam

Question 4

What Ix would you do in UC?

Answer 4

1) Sigmoidoscopy/ colonoscopy
2) Biopsy
3) AXR
4) Stool sample MCS (x3)
5) FBE, ESR
6) LFTs and U&Es

Question 5

What would your DDx be?

Answer 5

1) UC
2) CD
3) Infectious colitis
4) Ischaemic colitis
5) Colorectal Ca
6) Diverticulitis
7) Haemarroids

Question 6

Complications from UC

Answer 6

1) Perforation + bleeding
2) Toxic megacolon
3) Colon Ca
4) Adenocarcinoma
5) Backwash ileitis
6) Obstruction (2’ to fibrosis)

Question 7

What are some features of toxic megacolon

Answer 7

1) Dilation of necrotic bowl >6cm on AXR
2) Avoid c’scope (risk of perforation)
3) pain, fever, tachyC, dehydration, bleeding
4) Mx= emergency colectomy

Question 8

Mx of UC

Answer 8

1) 5-ASA: E.g. sulfasalazine (long term Mx PO/PR)
2) Corticosteroids (for acute disease, no real long term role)
4) Correct fluid + electrolyte imbalances
5) Surgery-> ileostomy or colectomy

Question 9

How does UC start

Answer 9

Starts in rectum and extends proximally. Always in continuity (no skip lesions)

Question 10

Features of UC on colonscopy

Answer 10

1) Continuous lesions
2) Red, raw mucosa
3) Oedematous
4) Pseudopolyps (granulation tissue growing over ulcers)

Question 11

Features of UC on histo

Answer 11

1) Crypt abscesses
2) Mucin depletion of goblet cells
3) Mucosal involvement only