Ulcerative Colitis

Question 1

Define ulcerative colitis

Answer 1

a type of inflammatory bowel disease that characteristically involves the rectum and extends proximally to affect a variable length of the colon. It is recognised as a multifactorial polygenic disease, as the exact aetiology is still unknown

• Affects the mucosal layer
• Affects the rectum extending proximally
• Continuous inflammation
• Red, inflamed, friable mucosa
• Crypt ulcers
• Pseudopolyps

Question 2

What are the causes/risk factors of ulcerative colitis?

Answer 2

Unknown aetiology but there seems to be interplay between genetic and environmental
factors

Genetic factors
• Family history (greater genetic
association in CD than UC)
• CARD15 (NOD2)
• HLA-B27
• Increased serum p-ANCA

Environmental factors
• Smoking (increases risk of CD but
reduces risk of UC)
• NSAIDs
• High sugar and fat intake
• Chronic stress and depression
• Intestinal dysbiosis

Question 3

What are the symptoms of ulcerative colitis?

Answer 3

• Abdominal pain/cramps
• Diarrhoea
• Fever
• Fatigue/malaise
• Weight loss
• Bloody diarrhoea
(with mucus)
• Tenesmus
• Urgency

Question 4

What are the signs ulcerative colitis?

Answer 4

• Weight loss
• Clubbing
• Abdominal tenderness
• Signs of anaemia
• Uveitis

Question 5

What are the investigations for ulcerative colitis?

Answer 5

Bloods
• FBC
- Low Hb
- High WCC
- High platelet count
• Raised ESR/CRP
• Low albumin
• Deranged LFTs (associated liver
disease)

Stool
• MC&S – exclude infectious colitis
• Faecal calprotectin – indicates
migration of neutrophils to intestinal
mucosa i.e. inflammation;
distinguishes IBD from IBS and
assesses disease severity
AXR – dilated bowel loops indicates ileus,
exclude toxic megacolon

Flexible sigmoidoscopy or colonoscopy with
biopsy
• Determines severity
• Detect dysplasia

Serology
• Positive p-ANCA

Barium enema
• Mucosal ulceration
• Featureless colon
• Thumbprinting

Question 6

What is the management for ulcerative colitis?

Answer 6

Conservative
• Education and advice

Medical
• 5-ASA analogues e.g. mesalazine, sulfasalazine
• Steroids e.g. prednisolone, budesonide
• Immunosuppressants e.g. azathioprine, cyclosporin, mercaptopurine, methotrexate
• TNF-alpha inhibitors e.g. infliximab, adalimumab

Indications for surgery
• Failure of medical therapy
• Complications
• Failure to thrive in children

Acute exacerbations
• IV fluids
• IV corticosteroids
• Ciclosporin if no improvement within
72h
• Antibiotics
• Surgery

Conservative
• Regular colonoscopic surveillance

Inducing remission
• Mild
o Oral +/- topical 5-ASA
• Moderate
o High dose oral 5-ASA
o +/- topical 5-ASA or oral
beclomethasone
• If no improvement after 4 weeks add
prednisolone or tacrolimus
• Infliximab if severe

Maintaining remission
• Oral +/- topical 5-ASA
• Azathioprine, mercaptopurine

Surgical
• Proctocolectomy with ileostomy
• Colectomy with ileo-anal pouch

Question 7

What are the complications of ulcerative colitis?

Answer 7

• Haemorrhage
• Perforation
• Toxic megacolon
• Colonic carcinoma
• Gallstones
• Primary sclerosing cholangitis