Ulcerative Colitis Flashcards
Ulcerative colitis?
- Ulcerative colitis (UC) is a form of inflammatory bowel disease.
- Inflammation always starts at rectum (hence it is the most common site for UC), never spreads beyond ileocaecal valve and is continuous.
- The peak incidence of ulcerative colitis is in people aged 15-25 years and in those aged 55-65 years.
The initial presentation?
The initial presentation is usually following insidious and intermittent symptoms. Features include:
- bloody diarrhoea
- urgency
- tenesmus
- abdominal pain, particularly in the left lower quadrant
- extra-intestinal features
Questions regarding the ‘extra-intestinal’ features of inflammatory bowel disease are common:
Common to both Crohn’s disease (CD) and Ulcerative colitis (UC):
Related to disease activity
Arthritis: pauciarticular, asymmetric
Erythema nodosum
Episcleritis
Osteoporosis
Arthritis is the most common extra-intestinal feature in both CD and UC
Episcleritis is more common in CD
Unrelated to disease activity
Arthritis: polyarticular, symmetric
Uveitis
Pyoderma gangrenosum
Clubbing
Primary sclerosing cholangitis
Primary sclerosing cholangitis is much more common in UC
Uveitis is more common in UC
Pathology?
- red, raw mucosa, bleeds easily
- no inflammation beyond submucosa (unless fulminant disease)
- widespread ulceration with preservation of adjacent mucosa which has the appearance of polyps (‘pseudopolyps’)
- inflammatory cell infiltrate in lamina propria
- neutrophils migrate through the walls of glands to form crypt abscesses
- depletion of goblet cells and mucin from gland epithelium
- granulomas are infrequent
Barium enema?
- loss of haustrations
- superficial ulceration, ‘pseudopolyps’
- long standing disease: colon is narrow and short -‘drainpipe colon’
