Ulcerative colitis

Question 1

definition of ulcerative colitis

Answer 1

inflammatory bowel disease (IBD) with chronic mucosal inflammation of the COLON and CECUM

15–35 years
smaller peak in ppl > 55
whits&jews>

main sx
bloody diarrhea, abdominal pain, and fever.

dg
(p-ANCA) levels ncreased in patients with ulcerative colitis(dx)
:endoscopy w/ biopsyy
confirms dg

rx:
nicotein teetotal

5-asaderiaftives, CS, immunosuppressants

proctocolectomy

comp: colorectal cancer

Question 2

pathophys of ulcerative colitis

Answer 2

1) exposure to RF causes Autoantibodies (pANCA) against cells of the intestinal epithelium

2)Th2cells
Activate lymphatic cells in bowel walls (T-cells, B-cells, plasma cells) → enhanced immune reaction causes cytotoxic effect on colonic epithelium → inflammation with local tissue damage (ulcerations, erosions, necrosis) in the submucosa and mucosa

Question 3

how does ulcerative colitis distribute in the colon

Answer 3

ascending inflammation beginning in the rectum and spreading continuously throughout the colon

Question 4

what is p-ANCA

Answer 4

autoantibody against myeloperoxidase granules

myeloperoxidase granules cause neutrophil to produce ROS which damages host tissue (can be stim by p-ANCA)

p-ANCA levels are increased in patients with

ulcerative colitis, autoimmune systemic vasculitis (especially Churg-Strauss syndrome and microscopic polyangiitis) primary sclerosing cholangitis.

Question 5

GI clinical features of UC

Answer 5

GI
-Bloody diarrhea with mucus

• Abdominal pain and cramps
• Tenesmus distressing and persistent but ineffectual urge to empty the rectum or bladder.

Question 6

non 4GI sx of UD

Answer 6

most common: Uveitis!!!
Primary sclerosing cholangitis (PSC): up to 90% of all patients

Joints: arthritis, ankylosing spondylitis, sacroiliitis

Skin manifestations: erythema nodosum, pyoderma gangrenosum
Episcleritis
Aphthous stomatitis

delayed puberty

Question 7

UC pathoanatomy

Answer 7

intestinal inflammation is limited to the mucosa and submucosa.
(transmural inflamm in CD)

causes pseudopolyps(intact remnants of intestinal wall)

LEAD PIPE apperance d/2 loss of haustra

Question 8

histology

Answer 8

(neutrophils) infiltration: limited to mucosa and submucosa

Crypt abscesses

Question 9

dx of UC

Answer 9

crohn’s disease

Infectious colitis

Ischemic colitis

anyother cause of diarrhoa (coeliac)

Question 10

non surgical rx of UC

Answer 10

general
-Rehydration
-Supplementation in the case of deficiencies
severe episode, conside parenteral nutrition.

medical induction & maintenance of remission

MILD
-1st-line treatment: topical 5-aminosalicylic acid derivatives (5-ASAs) administered as suppositories or enemas
(Anti-inflammatory and immunosuppressive effects)

MODERATE
oral and topical 5-ASAs

SEVERE
high‑dose oral and topical 5-ASAs and oral corticosteroids

REFACTORY TO CS
!!!!cyclosporine!!!!

Question 11

surgical rx of UC

Answer 11

Proctocolectomy with an ileal pouch-anal anastomosis

Question 12

surgical indications

Answer 12

complication refactory to med rx

elective surgery in case of dysplasia or severe relapses

Question 13

complications

Answer 13

Gastrointestinal bleeding (both acute and chronic)

Toxic megacolon

Perforation →peritonitis

Fulminant colitis
↑ Risk of cancer colorectal carcinoma

Question 14

prognosis

Answer 14

normal life expectancy