Ulcerative Colitis Flashcards
What is ulcerative colitis?
A relapsing and remitting inflammatory disorder of the colonic mucosa
What part of the bowel does UC affect?
May affect just the rectum, or extend to involve part of the colon, or the entire colon. It never spreads proximal to the ileocaecal valve
What is the exception to UC never spreading past the ileocaecal valve?
Backwash ileitis
Which ethnic group is UC most prevalent among?
Caucasian
What age is UC most common?
It follows a bimodal distribution between 15-25 years for most cases, with a smaller peak of incidence between 55-65 years
Which gender is most commonly affected by UC?
Equal
What course does UC typically follow?
Relaxing and remitting course
When might UC be life-threatening?
In a severe fulminant exacerbations
What can a severe fulminant exacerbation of UC cause?
- Severe systemic upset
- Toxic megacolon
- Colonic perforation
- Death
What is the pathophysiology of UC?
An inappropriate immune response against colonic flora in genetically susceptible individuals in hyperaemic and haemorrhagic colonic mucosa, with or without pseudopolyps formed from inflammation
How far can punctuate ulcers extend in UC?
May extend deep into the lamina propria
Is inflammation transmural in UC?
Not normally
What is UC characterised by?
Diffuse continual mucosal inflammation of the large bowel, beginning in the rectum and spreading proximally
What histological changes may be seen in UC?
- Inflammation of mucosa and submucosa
- Crypt abscesses
- Goblet cell hypoplasia
What can repeated cycles of ulceration and healing in UC lead to?
Raised areas of inflamed tissue termed ‘pseudopolyps’
How is UC differentiated from Crohn’s disease?
By continuous inflammation which is limited to the mucosa
What is the aetiology of UC?
The exact aetiology is unknown, but current theories suggest it develops as an interaction between genetic factors and environmental triggers
What effect does smoking have on the risk of UC?
It is protective against UC
What is a strong risk factor for UC?
Family history
What are the symptoms of UC?
- Episodic or chrnoic diarrhoea, with or without blood or mucus
- Crampy abdominal discomfort
- Increased bowel frequency
- Urgency
What % of cases of UC have blood in the stools?
90%
When might systemic features be present in UC?
In attacks
What systemic features may be present in UC attacks?
- Fever
- Malaise
- Anorexia
- Weight loss
What is the most common manifestation of UC?
Proctitis
What is proctitis?
Inflammation of the rectum
What are the symptoms of proctitis?
- PR bleeding and mucus discharge
- Increased frequency
- Urgency of defecation
- Tenesmus
What symptoms are patients with more widespread colonic involvement of UC more likely to experience?
- Bloody diarrhoea
- Clinical features of dehydration and electrolyte imbalance
What are the examination signs of UC?
May be none
In acute severe UC, might see tachycardia, fever, and a tender, distended abdomen
How many motions a day is considered to be mild UC?
4 or less
How many motions a day is considered to be moderate UC?
5
How many motions a day is considered to be severe UC?
6 or more
How much rectal bleeding is there in mild UC?
Small amount
How much rectal bleeding is there in moderate UC?
Moderate amount
How much rectal bleeding is there in severe UC?
Large amount
What is the resting pulse rate in mild UC?
<70bpm
What is the resting pulse rate in moderate UC?
70-90bpm
What is the resting pulse rate in severe UC?
<90
What is the temperature in mild UC?
Apyrexical
What is the temperature in moderate UC?
37.1 - 37.8
What is the temperature in severe UC?
>37.8
What are the haemoglobin levels in mild UC?
>100g/L
What are the haemoglobin levels in moderate UC?
105-100g/L