Ulcerative colitis

Question 1

What is ulcerative colitis?

Answer 1

Inflammatory bowel disease (IBD) characterized by chronic mucosal inflammation of the colon and cecum

Question 2

What is the epidemiology of ulcerative colitis?

Answer 2

15–35 years

Higher in the white than in the black, Hispanic, or Asian populations

Question 3

How is ulcerative colitis classified?

Answer 3

Truelove and Witts’

Question 4

What is the pathogenesis of ulcerative colitis?

Answer 4

(Dysregulation of intestinal epithelium) Increased permeability to bacteria. Activation of macrophages and dendritic cells, causing inflammation + NK cell recruitment
(Dysregulation of immune system) Inflammation with local tissue damage (ulcerations, erosions, necrosis)
Beginning in the rectum and spreading continuously proximally

Question 5

What are the risk factors of ulcerative colitis?

Answer 5

Genetic predisposition (e.g., HLA-B27 association)
Ethnicity
Family history
Hx of intestinal infection

Question 6

What are the protective factors of ulcerative colitis?

Answer 6

Appendectomy

Smoking

Question 7

What are the clinical features of ulcerative colitis?

Answer 7

(Intestinal) Bloody diarrhoea + mucus 
Fecal urgency 
Abdominal pain + cramp 
Tenesmus 
(Extraintestinal) Primary sclerosing cholangitis, osteoarthritis, ankylosing spondylitis, sacroiliitis

Question 8

How is ulcerative colitis diagnosed?

Answer 8

(Blood)↑ ESR, ↑ CRP, leukocytosis, Anemia, ↑ Perinuclear ANCA (pANCA)
(Stool analysis) Exclude infections, ↑Calprotectin and lactoferrin indicates infection
(Endoscopy)
(Plain radiograph) Lead pipe appearance via loss of haustra

Question 9

What is the treatment of ulcerative colitis?

Answer 9

(General) Supplementation of nutrition
(Medical) Antidiarrheal agents (e.g., loperamide)
(Mild UC) 5-aminosalicylic acid derivatives (5-ASAs, e.g. mesalazine) + topical steroid foams (e.g. hydrocortisone, prednisolone)
(Moderate) Prednisolone then 5-ASA
(Severe) IV steroids (e.g. hydrocortisone), thromboembolism prophylaxis
(Surgery) Proctocolectomy (surgical removal of the rectum and part or all of the colon)