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Stage 2: Inflammation > Ulcerative Colitis > Flashcards

Ulcerative Colitis Flashcards

1
Q

What two things are protective against ulcerative colitis?

A

1) Smoking

2) Appendicectomy

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2
Q

What are risk factors for IBD?

A
  • Enteric infections e.g. salmonella
  • NSAIDs, isotretinoin, antibiotics
  • Diet (simple sugars, urbanisation, microparticles, preservatives)
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3
Q

What area is affected by UC?

A

Mucosa of the large colon from anal margin upwards

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4
Q

What is the pathophysiology of UC?

A
  • Exaggerated mucosal T cell response to host microbiota and/or external stimuli in contact of genetically receptive host
  • Superficial inflammation linked to superficial symptoms (V&D)
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5
Q

What are symptoms of UC?

A
  • Rectal bleeding
  • Diarrhoea
  • Urgency
  • No/minimal abdominal pain (maybe at end)
  • No/minimal nutritional deficiency bc small bowel is unaffected
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6
Q

When are the two periods of onset of UC (bimodal)?

A

20-30 and 50

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7
Q

What tests are used to distinguish IBD from IBS?

A

1) Blood tests - raid CRP/ESR, anaemia, low albumin

2) Stool tests - raised faecal calprotectin

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8
Q

What is the gold standard test for diagnosis of UC?

A

Endoscopy

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9
Q

What does the endoscopy look like in UC?

A
  • Superficial ulcers

- Whole mucosa looks abnormal, unlike Crohn’s where it is patchy

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10
Q

What is proctitis UC?

A

Where the anus and rectum is involved

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11
Q

What is left-sided colitis UC?

A

Where the anus, rectum, sigmoid and descending colon are involved

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12
Q

What is pancolitis UC?

A

When the whole colon is affected

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13
Q

How do you treat an acute exacerbation of UC to induce remission?

A

1) Steroids - prednisolone, IV hydrocortisone

2) Aminosalicylates (oral and rectal) - 5-ASA, mesalazine

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14
Q

How do you treat UC to maintain remission?

A

1) Immunosuppressants e.g. azathioprine (thiopurines), methotrexate
2) Biologics e.g. adalimumab (anti-TNF), vedolizumab (anti-integrin)
3) Small molecules e.g. JAK inhibitors
4) Surgery (up to 20% over lifetime)

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15
Q

Describe surgery for UC

A
  • First remove colon and have to have stoma
  • Form pouch
  • Close stoma (but unlikely to have normal bowel function again)
  • Often affects fertility
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16
Q

What might an acute serious exacerbation of UC present with?

A
  • 2 months of increased frequency, urgency and rectal bleeding
  • Presents with 10 stools/day, rectal bleeding and abdominal pain
  • Started steroids 3 days ago but no benefit
  • Dehydration
  • Abdominal tenderness
17
Q

What is a red flag in the context of UC?

A

Abdominal pain

18
Q

What would you do if a patient meets 2 or more Trulove and Witt criteria (assesses severity of colitis)?

A

Admit

19
Q

What should you think of when you see an acutely unwell patient with known UC?

A

Infection - might have been put on steroids when actually need abx

20
Q

What investigations would you do for someone presenting with acute UC?

A
  • Blood test - FBC, U&Es, LFTs, CRP
  • AXR (and CXR)
  • Stool tests - MC&S, C diff
  • Sigmoidoscopy - to exclude CMV superadded infection
21
Q

What scan should you do for everyone that comes in with acute UC?

A

AXR

22
Q

What is a serious complication that requires surgery that can be picked up on AXR?

A

Toxic megacolon/leadpipe colon - v dilated dark vowel, lots of air, contracts, will eventually rupture if not treated

23
Q

How would you manage someone with an acute UC exacerbation?

A
  • IV hydrocortisone
  • LMWH (even though bleeding, inflammation is pro-coagulant, easier to treat bleeding than clot)
  • Daily blood tests and review
24
Q

What is rescue therapy for someone with acute UC exacerbation on day 3?

A

IV ciclosporin or infliximab

25
Q

What is the Travis criteria?

A

On day 3 of admission, if CRP > 45 or bowels open > 8 times a day, chance of colectomy on that admission is 85%

26
Q

How would you discharge a patient with acute UC exacerbation?

A
  • Weaning course of prednisolone
  • Next infliximab infusion booked
  • Start azathioprine as outpatient
  • Sigmoidoscopy at week 14 to assess endoscopic response
27
Q

What are the key histological features of UC?

A

Crypt abscesses and mucosal inflammation

28
Q

What is key when treating acute UC?

A

1) IV steroids are key

2) Day 3 assessment to decide on rescue therapy or surgery

29
Q

How do you optimise medical treatment in IBD?

A

With drug and antibody levels

30
Q

What is the M:F ratio for IBD?

A

1:1

31
Q

What type of disease is IBD?

A

Autoimmune

32
Q

What is the typical presentation of UC?

A
  • Diarrhoea
  • Blood in stools
  • (Cramping, colicky abdominal pain)
  • Faecal urgency and frequency
  • Tenesmus (feeling of urgency to poop)
  • Weight loss
33
Q

How is IBD investigated?

A
  • Faecal calprotectin via faecal sample
  • Stool culture and microscopy (infection)
  • Bloods - FBC, U&E, LFTs, ESR, CRP
  • Colonoscopy + ileal intubation + biopsy
34
Q

How is IBD managed?

A
  • Topical medication
  • Oral medication - steroid, azathioprine/mercaptopurine/5-ASA
  • Surgical if failure of medical treatment
  • Surveillance - susceptible to cancer
35
Q

What are the surgical options for UC?

A

1) Emergency total colectomy with ileostomy (remove everything, anything left is cancer risk)
2) Colectomy with ileostomy and rectal preservation
3) Colectomy and ileorectal anastomosis (elective) - in terminal ileum faeces more fluid, would have to go to toilet many times a day but no stoma
4) Restorative proctocolectomy - ileoanal pouch (most popular)
5) Panproctocolectomy - permanent stoma, curative

36
Q

In what UC patients would you carry out surveillance for colorectal carcinoma after surgery?

A

In those whose symptoms started > 10 years ago and their rectum remains post surgery

37
Q

What is IBD?

A

Increase in pro-inflammatory cytokines which cause inflammation of the bowel mucosa

Stage 2: Inflammation (39 decks)

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