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gastrointestinal > Ulcerative Colitis > Flashcards

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
Q

What advice do you give to someone with UC?

A

Patient education and support
Treat complications
Regular colonoscopic surveillance

26
Q

When is surgery used for UC?

A

If medical treatment fails
If there is the presence of complications
To prevent colonic carcinoma

27
Q

What are the two surgical procedures we can do for UC?

A

Proctocolectomy with ileostomy

Ileo-anal pouch formation

28
Q

What are the Gastrointestinal Complications of UC?

A 
Haemorrhage 
Toxic megacolon 
Perforation 
Colonic Carcinoma 
Gallstones 
PSC
29
Q

What are the Extra-GI manifestations of UC?

A 
Uveitis 
Renal Calculi
Arthropathy
Sacroiliitis 
Ankylosing Spondylitis 
Erythema nodosum 
Pyoderma gangrenosum 
Osteoporosis (from chronic steroid use)
Amyloidosis
30
Q

What is the prognosis for patients with UC?

A

Normal life expectancy

31
Q

What are poor prognostic factors for UC?

A 
Low albumin (< 30 g/L)
PR blood 
Raised CRP
Dilated loops of bowel
8 + bowel movements per day
Fever

gastrointestinal (61 decks)

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