Ulcerative Colitis Flashcards
Differentiate UC vs Crohns
UC: Always starts in rectum Continuous Mucosa and submucosal involvement only Crypt abscesses Decreased incidence in smokers
Crohns: Mouth to anus Skip lesions Transmural inflammation (causing...) Fissuring ulcers Lymphoid and neutrophil aggregates Non-caseating granulomas Increased incidence in smokers
Epidemiology of UC
Normally presents in young adults (but 2nd peak aged 60-70)
A response to env triggers in genetically susceptible individuals (2 hit theory)
Smoking decreases risk
Up to 50% relapses associated with gastroenteritis due to recognised pathogens (take stool sample)
Cardinal symptoms of UC
Bloody diarrhoea (incl nocturnal symptoms)
Urgency
Tenesmus (feeling of incomplete emptying)
Investigations of UC
Blood:
FBC (incl platelet count- inflammatory marker) CRP (inflammatory marker), U&E (dehydration: K)
Stool sample:
MC&S, C Diff toxin
Radiological:
Toxic megacolon, extent of inflammation, proximal comstipayion
Endoscopy:
Flexible sigmoidoscopy, biopsy, colonoscopy (later: risk perforation in acute flare)
Extra-intestinal manifestations of UC
Related to disease activity: Erythema nodosum Apthous ulcers Episcleritis Acute arthropathy Pyoderma gangrenosum Anterior uveitis
Unrelated to disease activity:
Sacroileitis
Ankylosing spondylitis
Primary sclerosing cholangitis
Pharmacological Treatment of UC
LMWH (IBD flares = prothrombotic state)
Steroids (induce remission in relapses)
5-ASAs (maintinence of remission)
Azathioprine / 6MP (immunosuppression)
Ciclosporin (immunosuppression: salvage therapy)
Biologics (anti TNF)
Laxatoves (for proximal comstipation)
Steroids:
Example
considerations
E.g. Prednisolone
Need bone protection as IBD risk factor for osteoporosis then multiplied
(Give bisphosphonates)
Need to wean off dose over number of weeks
5 ASAs
Examples
Considerations
Pentasa, Asacol
Olsalazine, Sluphasalazine
Rapidly absorbed from jejunum so needs to be delivered to colonic mucosa e.g. Topically, pharmacological modification
Azathioprine / 6MP
When used
Considerations
Steroid sparing agents, used in patients intolerant of corticosteroids, requiring multiple doses, have many relapses
Onset of action takes 6 weeks
Require monitoring & use of sun block
Mercaptopurine the active metabolite and often tolerated by those who cant tolerate Azathioprine
Ciclosporin
Comsiderations
Rapid onset of action
Mainly a bridge to use of Azathioprine
Surgical management of UC
Emergency: colectomy (toxic megacolon, acute colitis not responding to medication)
Elective: steroid dependent, patient choice, high grade dysplasia / cancer
UC definition
Inflammatory bowel disease that is characterised by diffuse inflammation of the colonic mucosa
Affects the rectum and extends proximally (to varying degrees)
