Ulcerative Colitis

Question 1

more common in ____

Answer 1

males

Question 2

affects the ___ extending proximally

Answer 2

rectum

Question 3

what are the symtoms

Answer 3

• Diarrhoea and bleeding - may have mucous/pus
• Increased bowel frequency - NEED TO FIND OUT HOW OFTEN
• Urgency, tenesmus and incontinence
• Night rising
• Lower abdo pain (LIF)
• (Proctitis can cause constipation)

Question 4

what is important in the history?

Answer 4

Recent travel 
Antibiotics
NSAIDS
Family history 
Smoking 
SKin, eyes, joints

Question 5

what extraintestinal skin manifestations may you get with UC?

Answer 5

erythema nodosum

pyoderma gangrenosum

clubbing

Question 6

what extraintestinal joint manifestations may you get with UC?

Answer 6

• spondylitis, sacroileitis, Peripheral arthritis

- Axial, peripheral joints

Question 7

what extraintestinal eye manifestations may you get with UC?

Answer 7

uveitis

Question 8

what extraintestinal circulation manifestations may you get with UC?

Answer 8

phlebitis

Question 9

may have deranged ___

Answer 9

LFTs

Question 10

may get ____ stones

Answer 10

oxalate renal

Question 11

____ and ____ are GI problems associated with UC

Answer 11

PSC and gallstones

Question 12

what may be present on mouth examination

Answer 12

apthous mouth ulcers

Question 13

what tests would you order to make an exclusion

Answer 13

Stool studies - to exclude campylobacter, c.diff, salmonella, e.coli, amoeba

Question 14

what tests would you do?

Answer 14

blood: FBC, ESR, CRP, U and E, LFT, blood culture

plain AXR

• colonoscopy

Question 15

why do a plain AXR

Answer 15

can be used to rule out perforation and toxic megacolon at first presentation

Question 16

on an AXR you may see -___/____ ___

Answer 16

thumbprinting/ lead piping

Question 17

colonoscopy may show _____ mucosal ulceration where the ulcers have a ___ base

Answer 17

superficial , broad base

Question 18

inflammation in UC is confined to the ___ and ____ except in ____ ____

Answer 18

Inflammation confined to the mucosa and submucosa except in toxic megacolon

Question 19

on colonoscopy may see ___ mucosa and diffuse erythema and may find _______

Answer 19

granular , pseudopolyps

Question 20

what are pseudopolyps?

Answer 20

The repeated cycle of ulceration, alternating with the deposition of granulation tissue during the healing phase, results in the development of raised areas of inflamed tissue that resemble polyps.

Question 21

histologically there is the absence of ___ cells and ____ distortion and may even get crypt ___

Answer 21

histologically there is the absence of goblet cells and crypt distortion and may even get crypt abscess

Question 22

what are the complications of UC?

Answer 22

• colorectal cancer
• also cholangioma - if have PSC
• intractable disease
• toxic megacolon
• blood loss
• electrolyte disturbances
• anal fissures (uncommon)

Question 23

what electrolyte disturbance may arise with UC?

Answer 23

hypokalaemia

Question 24

toxic megacolon requires an emergency_____

Answer 24

colectomy

Question 25

what is the differential diagnosis for UC

Answer 25

• Crohn’s disease
• Indeterminate colitis
• Radiation colitis
• Infectious colitis
• Diverticulitis
• IBS
• Mesenteric ischaemia
• Vasculitis

Question 26

WHAT WOULD MAKE YOU THINK RADIATION colitis instead of UC?

Answer 26

Radiation colitis - if have a history of receiving radiotherapy especially to pelvic area

Question 27

what would make you think infectious colitis instead of UC?

Answer 27

Infectious colitis - history of recent exposure or travel

Question 28

what would make you think diverticulitis instead of UC?

Answer 28

Diverticulitis - older age, fever nausea, diarrhoea or constipation

Question 29

what would make you think mesenteric ischaemia instead of UC?

Answer 29

history of heart disease