Ulcerative colitis Flashcards
What is Ulcerative colitis (UC)?
Diffuse continual mucosal inflammation of the large bowel that begins in the rectum and spreads proximally
What type of inflammation occurs in UC?
Mucosa only
What are the microscopic changes in UC?
Crypt absess formation, reduced goblet cells, non-granulomatous
What are the macroscopic changes in UC?
Continuous inflammation proximal from rectum, psuedopolyps and ulcers may form
What are the clinical features of UC?
Insidious onset, bloody diarrhoea, proctitis (inflammation confined to rectum) PR bleeding and mucus discharge, increased frequency, urgency of defecation and tenesmus, if more widespread then may have dehydration, electrolyte imbalance, malaise, anorexia, low grade pyrexia
What are the extra-intestinal manifestations of UC?
Enteropathic arthritis, nail clubbing, erythema nodosum, episcleritis, anterior uveititis or iritis, primary sclerosing cholangitis
What are the differential diagnosis for UC?
Crohns, chronic infections, mesenteric ischaemia, radiation colitis, malignancy, IBS, coeliac disease
What investigations would be done for UC?
Routine bloods, looking for anaemia, low albumin and inflammation, LFTs may be come deranged due to coagulation cascade effects in large inflammatory response, Faecal calprotectin and stool sample
What is the imaging for UC?
Colonoscopy with biopsy looking for ulcers and pseudo polyps, can do a flexible sigmoidoscopy, AXR in acute exacerbations or CT imaging to look for toxic megacolon or bowel perforation
What would the features of UC be on AXR?
Mural thickening and thumb printing, lead pipe colon
What is the medical management for UC?
Corticosteroids and immunosuppressive agents such as mesalazine
How is UC cured?
Total proctocolectomy with the patients requiring and ileostomy
What are the complications of UC?
Toxic megacolon, colorectal carcinoma, osteoporosis, pouchitis
