Ulcerative Colitis Flashcards

1
Q

What is ulcerative colitis?

A

A relapsing and remitting inflammatory disorder of the colonic mucosa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What part of the bowel does UC affect?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the exception to UC never spreading past the ileocaecal valve?

A

Backwash ileitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Which ethnic group is UC most prevalent among?

A

Caucasian

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What age is UC most common?

A

It follows a bimodal distribution between 15-25 years for most cases, with a smaller peak of incidence between 55-65 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Which gender is most commonly affected by UC?

A

Equal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What course does UC typically follow?

A

Relaxing and remitting course

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

When might UC be life-threatening?

A

In a severe fulminant exacerbations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What can a severe fulminant exacerbation of UC cause?

A
  • Severe systemic upset
  • Toxic megacolon
  • Colonic perforation
  • Death
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the pathophysiology of UC?

A

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 well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How far can punctuate ulcers extend in UC?

A

May extend deep into the lamina propria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Is inflammation transmural in UC?

A

Not normally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is UC characterised by?

A

Diffuse continual mucosal inflammation of the large bowel, beginning in the rectum and spreading proximally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What histological changes may be seen in UC?

A
  • Inflammation of mucosa and submucosa
  • Crypt abscesses
  • Goblet cell hypoplasia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What can repeated cycles of ulceration and healing in UC lead to?

A

Raised areas of inflamed tissue termed ‘pseudopolyps’

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How is UC differentiated from Crohn’s disease?

A

By continuous inflammation which is limited to the mucosa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the aetiology of UC?

A

The exact aetiology is unknown, but current theories suggest it develops as an interaction between genetic factors and environmental triggers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What effect does smoking have on the risk of UC?

A

It is protective against UC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is a strong risk factor for UC?

A

Family history

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the symptoms of UC?

A
  • Episodic or chrnoic diarrhoea, with or without blood or mucus
  • Crampy abdominal discomfort
  • Increased bowel frequency
  • Urgency
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What % of cases of UC have blood in the stools?

A

90%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

When might systemic features be present in UC?

A

In attacks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What systemic features may be present in UC attacks?

A
  • Fever
  • Malaise
  • Anorexia
  • Weight loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the most common manifestation of UC?

A

Proctitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is proctitis?

A

Inflammation of the rectum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are the symptoms of proctitis?

A
  • PR bleeding and mucus discharge
  • Increased frequency
  • Urgency of defecation
  • Tenesmus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What symptoms are patients with more widespread colonic involvement of UC more likely to experience?

A
  • Bloody diarrhoea
  • Clinical features of dehydration and electrolyte imbalance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are the examination signs of UC?

A

May be none

In acute severe UC, might see tachycardia, fever, and a tender, distended abdomen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

How many motions a day is considered to be mild UC?

A

4 or less

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

How many motions a day is considered to be moderate UC?

A

5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

How many motions a day is considered to be severe UC?

A

6 or more

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

How much rectal bleeding is there in mild UC?

A

Small amount

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

How much rectal bleeding is there in moderate UC?

A

Moderate amount

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

How much rectal bleeding is there in severe UC?

A

Large amount

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is the resting pulse rate in mild UC?

A

<70bpm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is the resting pulse rate in moderate UC?

A

70-90bpm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is the resting pulse rate in severe UC?

A

<90

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What is the temperature in mild UC?

A

Apyrexical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What is the temperature in moderate UC?

A

37.1 - 37.8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What is the temperature in severe UC?

A

>37.8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What are the haemoglobin levels in mild UC?

A

>100g/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What are the haemoglobin levels in moderate UC?

A

105-100g/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What are the haemoglobin levels in severe UC>

A

<105g/L

44
Q

What is the ESR level in mild UC?

A

<30

45
Q

What is the ESR level in severe UC?

A

>30

46
Q

How is UC investigated?

A
  • Bloods
  • Colonoscopy and biopsy
  • Stool MC&S
  • Faecal calprotectin
  • AXR
47
Q

What bloods are done in UC?

A
  • FBC
  • ESR
  • CRP
  • U&E
  • LFTs
  • Blood cultures
48
Q

How is the definitive diagnosis of UC made?

A

Via colonoscopy with biopsy

49
Q

What are the characteristic macroscopic findings on colonoscopy in UC?

A

Continuous inflammation with possible ulcers and pseudopolyps

50
Q

Describe the use of flexible sigmoidoscopy in the investigation of UC

A

A flexible sigmoidoscopy may be sufficient, and in clinical practice full colonoscopy is only required if the diagnosis is unclear

51
Q

When should colonoscopy be avoided in UC?

A

Acute severe exacerbations

52
Q

Why is stool MC&S done in suspected UC?

A

To rule out infectious causes

53
Q

What infectious causes can be ruled out using MC&S in suspected UC?

A
  • Campylobacter
  • C. difficile
  • Salmonella
  • Shigella
  • E. Coli
  • Amoebae
54
Q

Why is an AXR required in an acute exacerbation of UC?

A

To determine if toxic megacolon and/or bowel perforation have occured

55
Q

What are the AXR features of acute UC?

A
  • Mural thickening and thumb printing
  • Lead-pipe colon in chronic cases
56
Q

What treatment will any acute attacks of UC warrant?

A
  • Aggressive fluid resuscitation
  • Nutritional suppport
  • Prophylactic heparin
57
Q

Why is prophylactic heparin required in acute attacks of UC?

A

Due to the promthrombotic state of IBD flares

58
Q

What approach does NICE guidelines recommend in an acute attack of UC?

A

A stepwise approach dependant on clinical severity and location of exacerbation

59
Q

What is step 1 in the management of mild to moderate UC with proctitis?

A

Topical mesalazine or sulfasalazine

60
Q

How is topical mesalazine or sulfasalazine administered?

A

Suppositories or enema, taking into account persons preferences

61
Q

What can be given if the person declines or cannot tolerate aminosalicylates in step 1 treatment of mild to moderate UC with proctitis?

A

Topical corticosteroids are second line

62
Q

What is step 2 in the management of mild to moderate UC with proctitis?

A

Addition of oral prednisolone to aminosalicylate therapy to induce remission

63
Q

When is step 2 treatment started in mild to moderate UC?

A

If there is no improvement after 4 weeks of step 1 therapy, or if symptoms worsen despite treatment

64
Q

What should be considered if there is inadequate response to oral prednisolone after 2-4 weeks of step 2 therapy for mild to moderate UC with proctitis?

A

Adding oral tacrolimus

65
Q

What is step 1 management of mild to moderate UC with left-sided or extensive inflammation?

A

High induction dose mesalazine or sulfasalazine

66
Q

What is second line in step 1 treatment of mild to moderate UC with left sided or extensive inflammation?

A

Oral prednisolone

67
Q

What is step 2 mangement of mild to moderate UC with left-sided or extensive inflammation?

A

Same as step 2 management for mild to moderate UC with proctitis

68
Q

What is step 1 in the management of severe UC?

A

IV corticosteroids, and consider need for surgery

69
Q

What medication is second line in the step 1 management of severe UC?

A

IV ciclosporin

70
Q

What is step 2 management for severe UC?

A

Consider adding IV ciclosporin to intravenous corticosteroids

71
Q

When should you consider surgery in step 2 management of severe UC?

A
  • Little or no improvement within 72 hours of starting IV corticosteroids
  • Symptoms worsen at any time, despite corticosteroid treatment
72
Q

How can remission be maintained in UC once any acute event has been controlled?

A

Using immunomodulators, such as mesalazine or sulfasalazine

73
Q

What is second line to aminosalicylates in the maintenance of remission in UC?

A

Infliximab, or an alternative monoclonal antibodies

74
Q

What should UC patients be referred to?

A
  • An IBD nurse specialist
  • Patient support groups
75
Q

When should enternal nutritional support be considered in UC?

A

In young patients with growth concerns

76
Q

What should enteral nutrition in UC be provided with close support from?

A

A nutritional team

77
Q

When is colonoscopic surveillance offered in UC?

A

In people who have had the disease for >10 years with >1 segment of the bowel affected

78
Q

Why is colonoscopic surveillance offered in UC?

A

Due to the increased risk of colorectal malignancy

79
Q

What does the colonoscopic follow-up time frame depend on in UC?

A

The risk stratification of the disease following initial endoscopy

80
Q

What % of those with UC will at some point require surgery?

A

30%

81
Q

What are the indications for acute surgical treatment in UC?

A
  • Disease refractory to medical management
  • Toxic megacolon
  • Bowel perforation
82
Q

When might surgery be undertaken to reduce the risk of colonic carcinoma in UC?

A

If dysplastic cells are detected on routine monitoring

83
Q

What surgery is curative in UC?

A

Total proctocolectomy

84
Q

What is the problem with a total proctocolectomy?

A

The patient requires an ileostomy

85
Q

How can the requirement for an ileostomy be avoided in surgical UC patients?

A
  • Ileal pouch-anal anastomosis operation
  • Sub-total colectomy with preservation of rectum
86
Q

What happens in an ileal pough-anal anastomosis operation?

A

A pouch is formed from the loops of ileum, which acts as a reservoir for intestinal contents, which is then anastomosed to the anus, aiming to achieve faecal continence

87
Q

What can be done if symptoms persist following a sub-total colectomy?

A

The rectum can be exised at a later state

88
Q

What are the complications of UC?

A
  • Toxic megacolon
  • Colorectal carcinoma
  • Osteoporosis
  • Pouchitis
89
Q

When can a patient have the complication of pouchitis?

A

If they have an ileal pouch following an ileal pouch-anal anastomosis operation

90
Q

What is toxic megacolon?

A

A serious complication of UC, characterised by dilation of the colon to at least 6cm diameter on AXR

91
Q

How do patients with toxic megacolon typically present?

A
  • Severe abdominal pain
  • Abdominal distention
  • Pyrexia
  • Systemic toxicity
92
Q

How is toxic megacolon managed?

A

Urgent decompression of the bowel

93
Q

Why is decompression of the bowel required as soon as possible in toxic megacolon?

A

Due to the risk of perforation

94
Q

What is failure to respond to medical management an indication for in toxic megacolon?

A

Surgery

95
Q

What is the risk of colon cancer in UC related to?

A

Disease extent and activity

96
Q

What is the risk of colon cancer in those who have had pancolitis for 20 years?

A

5-10%

97
Q

How are colonic cancer precursor lesions spotted in UC?

A

Surveillance colonoscopy is performed every 1-5 years

98
Q

On what basis are biopsies taken during surveillance colonoscopy in UC?

A

Either random biopsies, or biopsies guided by differential uptake by abnormal mucosa of dye sprayed endoscopically

99
Q

What is pouchitis?

A

Inflmmation of an ileal pouch

100
Q

What are the typical symptoms of pouchitis?

A
  • Abdominal pain
  • Bloody diarrhoea
  • Nausea
101
Q

How should pouchitis be treated?

A

Metronidazole and ciprofloxacin

102
Q

What are the musculoskeletal manifestations of UC?

A

Enteropathic arthritis

103
Q

What joints does enteropathic arthritis typically affect?

A

Sacroiliac and other large joints

104
Q

What are the skin manifestations of UC?

A

Erythema nodosum

105
Q

What are the manifestations of UC in the eyes?

A
  • Episcleritis
  • Anterior uveitis
  • Iritis
106
Q

What are the hepatobiliary manifestations of UC?

A

Primary sclerosing cholangitis

107
Q

What is primary sclerosing cholangitis?

A

Chronic inflammation and fibrosis of bile ducts