Ulcerative Colitis Flashcards

1
Q

Define Ulcerative Colitis (UC)?

A

Chronic relapsing and remitting inflammatory disease affecting the large bowel

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2
Q

What is the main factor behind UC?

A

Genetic susceptibility

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3
Q

What are some of the other factors involved in UC?

A

Immune response to bacterial or self-antigens
Environmental factors
Altered neutrophil function
Abnormality in epithelial cell integrity

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4
Q

In percentage of patients is there a positive family history for UC?

A

15%

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5
Q

What are the associations of UC?

A

pANCA

PSC (70% of patients with PSC have UC)

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6
Q

What is the epidemiology of UC?

A

Uncommon before the age of 10 yrs
Peak onset: 20-40 yrs
Equal sex ratio up to the age of 40 yrs (higher in males from then on)

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7
Q

In what ethnicity is UC a higher prevalence?

A

Ashkenazi Jews

Caucasians

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8
Q

What are the presenting symptoms of UC?

A

Bloody or mucous diarrhoea (stool frequency depends on severity of disease)
Tenesmus and urgency
Crampy abdominal pain before passing sttol
Weight Loss
Fever
Extra-GI manifestations

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9
Q

What are some examples of Extra-GI manifestations of UC?

A

Uveitis
Scleritis
Erythema Nodosum
Pyoderma Gangrenosum

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10
Q

What are the signs of UC on physical examination?

A

Signs of Iron Deficiency Anaemia (e.g. conjunctival pallor)
Dehydration
Clubbing
Abdominal tenderness
Tachycardia
Blood, mucus and tenderness on PR examination

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11
Q

What investigations would you do for UC?

A
Bloods 
Stool
AXR
Flexible Sigmoidoscopy or Colonscopy (and biopsy)
Barium Enema
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12
Q

What Bloods would you do for UC?

A

FBC
High ESR or CRP
Low albumin
X-match if there is severe blood loss

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13
Q

What do you look for specifically on a FBC for UC?

A

Low Hb

High WCC

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14
Q

Why do we do stool analysis for UC?

A

Infectious Colitis is a differential diagnosis so a stool culture may be useful
Faecal calprotectin allows differentiation of IBS from IBD

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15
Q

How do we use Faecal Calprotectin?

A

It is raised in inflammatory processes (i.e IBD)

Both IBS and IBD can present with long-term diarrhoea

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16
Q

Why do we do an AXR for UC?

A

Rule out toxic megacolon

17
Q

Why do we do a Flexible Sigmoidoscopy or Colonoscopy (and biopsy)?

A

Determines severity
Histological Confirmation
Detection of dysplasia

18
Q

Why do we do a Barium Enema for UC?

A

Shows mucosal ulceration with granular apperance and filling defects (due to pseudopolyps)
Narrowed colon
Loss of haustral pattern - leadpipe appearance
Colonoscopy and barium enema may be DANGEROUS during an acute exacerbation - risk of perforation

19
Q

What are the Markers of Disease Activity for UC?

A
Decreased Hb 
Decreased Albumin 
Increased ESR and CRP 
Diarrhoea frequency
Bleeding 
Fever
20
Q

How is Diarrhoea Frequency used to judge the severity of UC?

A

< 4 = mild
4-6 = moderate
6+ = severe

21
Q

What is the management of an Acute Exacerbation of UC?

A
IV rehydration
IV corticosteroids 
Antibiotics 
Bowel rest 
Parenteral feeding may be necessary
DVT prophylaxis
22
Q

What do you do if there is a toxic megacolon for UC?

A

The patient is likely to need a proctocolectomy because toxic megacolon has a high mortality

23
Q

What is the management of Mild UC?

A

Oral or rectal 5-ASA derivatives (e.g. mesalazine, olsalazine, sulphasalazine)
and/or
Rectal Steroids

24
Q

What is the management of Moderate to Severe UC?

A

Oral Steroids
Oral 5-ASA
Immunosuppression (with azathioprine, cyclosporine, 6-mercaptopurine or infliximab (anti-TNF monoclonal antibody))

25
What advice do you give to someone with UC?
Patient education and support Treat complications Regular colonoscopic surveillance
26
When is surgery used for UC?
If medical treatment fails If there is the presence of complications To prevent colonic carcinoma
27
What are the two surgical procedures we can do for UC?
Proctocolectomy with ileostomy | Ileo-anal pouch formation
28
What are the Gastrointestinal Complications of UC?
``` Haemorrhage Toxic megacolon Perforation Colonic Carcinoma Gallstones PSC ```
29
What are the Extra-GI manifestations of UC?
``` Uveitis Renal Calculi Arthropathy Sacroiliitis Ankylosing Spondylitis Erythema nodosum Pyoderma gangrenosum Osteoporosis (from chronic steroid use) Amyloidosis ```
30
What is the prognosis for patients with UC?
Normal life expectancy
31
What are poor prognostic factors for UC?
``` Low albumin (< 30 g/L) PR blood Raised CRP Dilated loops of bowel 8 + bowel movements per day Fever ```