Ulcerative Colitis Flashcards
What part of the bowel is affected in ulcerative colitis?
The colon.
It starts at the rectum and spreads continuously.
It does not spread beyond the ileocaecal valve.
UC has a bimodal peak, what is it?
Aged 15-25 years and in those aged 55-65 years
Describe some features of UC?
- Bloody diarrhoea (More common than CD)
- Urgency
- Tenesmus
- Abdominal pain, particularly in the left lower quadrant
- Extra-intestinal features (see below)
What are some extra-intestinal features of UC that are related to disease activity?
- Arthritis: pauciarticular, asymmetric
- Erythema nodosum
- Episcleritis (CD>UC)
- Osteoporosis
What are some extra-intestinal features of UC that are unrelated to disease activity?
- Arthritis: polyarticular, symmetric
- Uveitis (More common in UC)
- Pyoderma gangrenosum
- Clubbing
- Primary sclerosing cholangitis (More common UC)
What pathological bowel changes do you see in UC?
- No inflammation beyond the submucosa (unless fulminant disease)
- Lamina propria is infiltrated by inflammatory cells.
- Crypt abscesses form.
- Depletion of goblet cells and mucin from gland epithelium.
What AXR sign can be seen in UC?
Lead piping
Due to loss of large bowel haustrations.
Thumb printing can also be seen but that is present in both UC and CD.
What surface antigen is associated with IBD?
HLA-B27
What other conditions are associated with HLA B27?
- Ankylosing spondylitis
- Reactive arthritis (Reiter’s syndrome)
- acute anterior uveitis
- Iritis
- Psoriatic arthritis
The severity of UC is usually classified as being mild, moderate or severe:
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Mild:
- <4 stools/day +/- bloody stools.
- No systemic disturbance.
- Normal ESR and CRP
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Moderate:
- 4-6 stools/day, varying amounts of blood.
- Minimal systemic disturbance.
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Severe:
- >6 bloody stools per day + features of systemic upset.
- Pyrexia, tachycardia, anaemia, raised inflammatory markers, abdominal tenderness, abdominal distension.)
- >6 bloody stools per day + features of systemic upset.
If someone has a severe flare, how should they be managed?
They should be admitted into hospital.
What is the medical management for inducing remission in UC?
- Treatment depends on the extent and severity of disease
- Rectal (topical) aminosalicylates or steroids.
-
Oral prednisolone is usually used second-line for patients who fail to respond to aminosalicylates.
- NICE recommend waiting around 4 weeks before deciding if first-line treatment has failed
- Severe colitis should be treated in hospital. Intravenous steroids are usually given first-line
What is the drug management for maintaining remission?
- Oral aminosalicylates e.g. mesalazine
- Azathioprine and mercaptopurine
- There is some evidence that probiotics may prevent relapse in patients with mild to moderate disease
NOTE: Methotrexate is not recommended for the management of UC (in contrast to Crohn’s disease)
