Ulcerative Colitis Flashcards
What two things are protective against ulcerative colitis?
1) Smoking
2) Appendicectomy
What are risk factors for IBD?
- Enteric infections e.g. salmonella
- NSAIDs, isotretinoin, antibiotics
- Diet (simple sugars, urbanisation, microparticles, preservatives)
What area is affected by UC?
Mucosa of the large colon from anal margin upwards
What is the pathophysiology of UC?
- 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)
What are symptoms of UC?
- Rectal bleeding
- Diarrhoea
- Urgency
- No/minimal abdominal pain (maybe at end)
- No/minimal nutritional deficiency bc small bowel is unaffected
When are the two periods of onset of UC (bimodal)?
20-30 and 50
What tests are used to distinguish IBD from IBS?
1) Blood tests - raid CRP/ESR, anaemia, low albumin
2) Stool tests - raised faecal calprotectin
What is the gold standard test for diagnosis of UC?
Endoscopy
What does the endoscopy look like in UC?
- Superficial ulcers
- Whole mucosa looks abnormal, unlike Crohn’s where it is patchy
What is proctitis UC?
Where the anus and rectum is involved
What is left-sided colitis UC?
Where the anus, rectum, sigmoid and descending colon are involved
What is pancolitis UC?
When the whole colon is affected
How do you treat an acute exacerbation of UC to induce remission?
1) Steroids - prednisolone, IV hydrocortisone
2) Aminosalicylates (oral and rectal) - 5-ASA, mesalazine
How do you treat UC to maintain remission?
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)
Describe surgery for UC
- First remove colon and have to have stoma
- Form pouch
- Close stoma (but unlikely to have normal bowel function again)
- Often affects fertility
What might an acute serious exacerbation of UC present with?
- 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
What is a red flag in the context of UC?
Abdominal pain
What would you do if a patient meets 2 or more Trulove and Witt criteria (assesses severity of colitis)?
Admit
What should you think of when you see an acutely unwell patient with known UC?
Infection - might have been put on steroids when actually need abx
What investigations would you do for someone presenting with acute UC?
- Blood test - FBC, U&Es, LFTs, CRP
- AXR (and CXR)
- Stool tests - MC&S, C diff
- Sigmoidoscopy - to exclude CMV superadded infection
What scan should you do for everyone that comes in with acute UC?
AXR
What is a serious complication that requires surgery that can be picked up on AXR?
Toxic megacolon/leadpipe colon - v dilated dark vowel, lots of air, contracts, will eventually rupture if not treated
How would you manage someone with an acute UC exacerbation?
- IV hydrocortisone
- LMWH (even though bleeding, inflammation is pro-coagulant, easier to treat bleeding than clot)
- Daily blood tests and review
What is rescue therapy for someone with acute UC exacerbation on day 3?
IV ciclosporin or infliximab
