Ulcerative Colitis Flashcards
What is UC?
UC is a relapsing and remitting inflammatory disorder of the colonic mucosa. It may affect just the rectum (proctitis, as in ~30%) or extend to involve part of the colon (left- sided colitis, in ~40%) or the entire colon (pancolitis, in ~30%). It ‘never’ spreads proximal to the ileocaecal valve (except for backwash ileitis).
What are the intestinal features of UC?
Hyperaemic/haemorrhagic colonic mucosa ± pseudopolyps formed by in- flammation. Punctate ulcers may extend deep into the lamina propria—inflammation is normally not transmural.
Continuous inflammation limited to the mucosa differentiates it from Crohn’s disease
Appendectomy + smoking protects
Starts in distal colon
M=F
What causes UC?
Inappropriate immune response against (?abnormal) colonic flora in genetically susceptibile individuals
What are complications of UC?
Severe bleeding, toxic megacolon, rupture of bowel, cancer
What are the symptoms of UC?
Episodic or chronic diarrhoea (± blood & mucus); crampy abdominal discomfort; bowel frequency relates to severity; urgency/tenesmus ≈ proctitis.
Systemic symptoms in attacks: fever, malaise, anorexia, decreased weight
What are the signs of UC?
Acute, severe –> fever, tachycardia, distended abdomen
What are the extra-intestinal signs of UC?
Clubbing, aphthous oral ulcers; erythema nodosum; pyoderma gangrenosum; conjunctivitis; episcleritis; iritis; large joint arthritis; sacroiliitis; ankylosing spondylitis; Primary sclerosing cholangitis; nutritional deficits.
What are the tests for UC?
Blood - FBC, ESR, CRP, U&Es, LFT, Blood Culture
Stool MC&S/CDT - exclude infection
Faecal Calprotectin
AXR - mucosal thickening, toxic megacolon
Lower Gi endoscopy - assess and biopsy
What is the treatment for mild UC? (2)
5-ASA (mesalazine) - PR for distal, PO for extensive
Prednisolone, if 5-ASA not working
What is the treatment for moderate UC?
oral Prednisolone 40mg/d for 1 week, then taper to induce remission
maintain on 5-ASA
monitor FBC and U&E at start, then at 3 months, then annually
What is the treatment for severe UC?
Admit for: IV hydration, IV hydrocortisone, VTE prophylaxis colectomy. Multiple stool samples to exclude infection.
What treatment is used for immunomodulation/maintain remission?
Patients flare on steroid tapering or require ≥2 courses of steroids/year:
azathioprine or mercaptopurine
What is a possible biologic therapy?
monoclonal antibodies to TNFalpha (infliximab, adalimumab, golimumab) or to adhesion molecules involved in gut lymphocyte trafficking (vedolizumab)
What is used to maintain remission?
oral aminosalicylates e.g. mesalazine
and
azathioprine and mercaptopurine
