Ulcerative colitis

Question 1

Where does uc affect?

Answer 1

Rectum —> colon

Sometimes affects terminal ileum if it gets that far

Question 2

How is UC distributed?

Answer 2

Continuous

Question 3

Does UC have strictures?

Answer 3

No

Question 4

Describe the microscopic changes.

Answer 4

Inflammation - mucosal layer only
Ulceration - broad and shallow
Has pseudopolyps
Crypt abscesses and goblet cells depleted

Question 5

What will be seen on a histological slide that differentiates this from Crohns?

Answer 5

Crypt abscesses

Depleted goblet cells

Question 6

Presentation?

Answer 6

Bloody and mucous diarrhoea
Abdo discomfort
Urgency

Question 7

Signs of a severe attack?

Answer 7

> 6 stools a day with blood
with
Fever, tachycardia, raised ESR/CRP, WCC and low Hb and albumin

Question 8

Investigation types?

Answer 8

Blood
Imaging
Stools

Question 9

Whats seen in blood?

Answer 9

Raised ESR, CRP and WCC

Low Hb and albumin

Question 10

Stool?

Answer 10

Calprotectin

50 normal
50 -200 equivalent
200+ elevated

Also testing for c.diff and campylobacter

Question 11

Imaging tests and why?

Answer 11

AxR - look at colonic wall thickening 
CxR - perforation 
CT scan
Barium enema 
Colonoscopy - for a biopsy

Question 12

What will a barium enema see?

Answer 12

Lead piping - loss of haustra

Question 13

What is a “megacolon”

Answer 13

abnormal dilation of the colon (>6cm)

Question 14

Treatment?

Answer 14

1st line - 5-ASA
2nd line - prednisolone

Surgery

Question 15

Types of surgery ?

Answer 15

Total/subtotal colectomy resulting in an ileostomy bag

Pouch surgery, where the unaffected colon is stretched to form a pouch and connected to rectum