Ulcerative Colitis Flashcards
Define Ulcerative Colitis (UC)?
Chronic relapsing and remitting inflammatory disease affecting the large bowel
What is the main factor behind UC?
Genetic susceptibility
What are some of the other factors involved in UC?
Immune response to bacterial or self-antigens
Environmental factors
Altered neutrophil function
Abnormality in epithelial cell integrity
In percentage of patients is there a positive family history for UC?
15%
What are the associations of UC?
pANCA
PSC (70% of patients with PSC have UC)
What is the epidemiology of UC?
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)
In what ethnicity is UC a higher prevalence?
Ashkenazi Jews
Caucasians
What are the presenting symptoms of UC?
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
What are some examples of Extra-GI manifestations of UC?
Uveitis
Scleritis
Erythema Nodosum
Pyoderma Gangrenosum
What are the signs of UC on physical examination?
Signs of Iron Deficiency Anaemia (e.g. conjunctival pallor)
Dehydration
Clubbing
Abdominal tenderness
Tachycardia
Blood, mucus and tenderness on PR examination
What investigations would you do for UC?
Bloods Stool AXR Flexible Sigmoidoscopy or Colonscopy (and biopsy) Barium Enema
What Bloods would you do for UC?
FBC
High ESR or CRP
Low albumin
X-match if there is severe blood loss
What do you look for specifically on a FBC for UC?
Low Hb
High WCC
Why do we do stool analysis for UC?
Infectious Colitis is a differential diagnosis so a stool culture may be useful
Faecal calprotectin allows differentiation of IBS from IBD
How do we use Faecal Calprotectin?
It is raised in inflammatory processes (i.e IBD)
Both IBS and IBD can present with long-term diarrhoea
Why do we do an AXR for UC?
Rule out toxic megacolon
Why do we do a Flexible Sigmoidoscopy or Colonoscopy (and biopsy)?
Determines severity
Histological Confirmation
Detection of dysplasia
Why do we do a Barium Enema for UC?
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
What are the Markers of Disease Activity for UC?
Decreased Hb Decreased Albumin Increased ESR and CRP Diarrhoea frequency Bleeding Fever
How is Diarrhoea Frequency used to judge the severity of UC?
< 4 = mild
4-6 = moderate
6+ = severe
What is the management of an Acute Exacerbation of UC?
IV rehydration IV corticosteroids Antibiotics Bowel rest Parenteral feeding may be necessary DVT prophylaxis
What do you do if there is a toxic megacolon for UC?
The patient is likely to need a proctocolectomy because toxic megacolon has a high mortality
What is the management of Mild UC?
Oral or rectal 5-ASA derivatives (e.g. mesalazine, olsalazine, sulphasalazine)
and/or
Rectal Steroids
What is the management of Moderate to Severe UC?
Oral Steroids
Oral 5-ASA
Immunosuppression (with azathioprine, cyclosporine, 6-mercaptopurine or infliximab (anti-TNF monoclonal antibody))
What advice do you give to someone with UC?
Patient education and support
Treat complications
Regular colonoscopic surveillance
When is surgery used for UC?
If medical treatment fails
If there is the presence of complications
To prevent colonic carcinoma
What are the two surgical procedures we can do for UC?
Proctocolectomy with ileostomy
Ileo-anal pouch formation
What are the Gastrointestinal Complications of UC?
Haemorrhage Toxic megacolon Perforation Colonic Carcinoma Gallstones PSC
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
What is the prognosis for patients with UC?
Normal life expectancy
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
