Ulcerative Colitis Flashcards
What is UC?
- Chronic inflammatory disease resulting in relapsing and remitting IBD of colonic mucosa
What are the types of UC?
- ulcerative proctitis
- left-sided colitis
- pancolitis
What are the features of UC that is different to Crohns?
*remember CLOSE UP
- Continuous inflammation
- Limited to colon and rectum
- Only superficial mucosa affected
- Smoking is protective
- Excrete blood and mucus
- Use aminosalicylates
- Primary Sclerosing Cholangitis
What is the Px of UC?
- Inappropriate immune response to colonic flora in genetically susceptible people
What age group does UC present in?
15-25 and 55-65
What is unhealthy but a protective factor for UC?
Smoking
What are the Sx for UC?
- GI related
- +/- bloody/mucus stool
- crampy abdominal discomfort
- tenesmus
- Systemic
- fatigue
- weight loss
- iron def. anaemia
What are the extraintestinal manifestations of UC?
- clubbing
- eythema nodosum
- conjunctivitis
- uveitis
- iritis
- large joint arthritis
- Ankylosing spondylitis
What Ix would you order for UC?
Bedside
- Observations
- ECG
- Urinalysis
- Stool culture - exclude infective colitia
- Faecal calprotectin (marker of intestinal inflammation)
Bloods
- Full blood count
- Liver function tests
- Urea & electrolytes
- CRP
- Arterial/venous blood gas
- Haematinics
- Magnesium
- Clotting
- Autoantibodies (e.g. p-ANCA)
Imaging
- AXR- if suspicious of toxic megacolon and assess proximal constipation
Special Test
- Flex sigmoidoscopy- safer choice
- Colonoscopy- look for proximal disease
What is calprotectin?
Protein released by intestines when inflammed
What criteria is used to assess severity of UC?
Truelove and Witts
What are the parameters measured in Truelove and Witts?
- Bowel motions
- rectal bleeding
- temperature
- resting pulse
- haemoglobin
- ESR
What are the Cx of UC?
*think acute and chronic
Acute
- toxic dilation of colon >6cm
- venous thromboembolism
Chronic
- colonic cancer
What are the Tx for UC to induce remission?
- If admittted to hospital - VTE prophylaxis (Heparin)
- Mild to moderate
- First line: meselazine (aminosalicylate) per rectal
- If remission is not achieved within 4 weeks, add an oral aminosalicylate
- if remission still not achieved add topical or oral corticosteroid
- Severe
- First line: IV corticosteroid
- IV ciclosporin if corticosteroid contraindicated
- IV steroid + IV ciclosporin - second lie
- Surgery
What medications are used to maintain remission?
1. Thiopurines (Azathioprine, mercaptopurine)
- Check TPMT enzyme before use
- SE: Bone marrow suppresion, pancreatitis, hepatoxicity
2. Biologics (infliximab, adalimumab)
What is the surgical option for UC?
- Panproctocolectomy + ileo-anal anastomosis (J pouch)
