Ulcerative Colitis

Question 1

What is UC?

Answer 1

A relapsing and remitting inflammatory disorder of the colonic mucosa

Question 2

Where is UC limited to?

Answer 2

From rectum to ileocaecal valve

Question 3

What causes UC?

Answer 3

An inappropriate immune response to colonic flora in genetically susceptible individuals

Question 4

What can form in severe UC?

Answer 4

Pseudopolyps, ulcers

Question 5

What feature of UC differentiates it from Crohn’s Disease?

Answer 5

Circumferential and continuous inflammation limited to mucosa, no skip lesions

Question 6

What layer is underneath the mucosa?

Answer 6

Submucosa

Question 7

What layer is underneath the submucosa and what makes up this layer?

Answer 7

Muscularis propria made up of circular and longitudinal muscle

Question 8

What is the outer layer of the colon?

Answer 8

Serosa

Question 9

What symptoms might someone with UC have?

Answer 9

Remissions and exacerbations, LLQ pain, abdominal cramps/discomfort, episodic or chronic diarrhoea +/- blood/mucus or urgency

Question 10

When might a patient experience systemic symptoms?

Answer 10

During UC attacks

Question 11

What systemic symptoms might a patient experience?

Answer 11

Fever, malaise, anorexia, wt loss

Question 12

What signs might a patient have in acute, severe UC?

Answer 12

Fever, tachycardia, tender and distended abdomen

Question 13

What extraintestinal signs might be present?

Answer 13

Clubbing, aphthous oral ulcers, nutritional deficits

Question 14

What blood results would you see?

Answer 14

Raised WCC, platelets, CRP and ESR, potentially anaemia

Question 15

How would you manage mild/moderate UC?

Answer 15

5-ASAs/Aminosalicylates + oral prednisolone if not responding

Question 16

How would you manage severe UC?

Answer 16

IV hydrocortisone, ciclosporin, infliximab

Question 17

What surgical option is there?

Answer 17

Colectomy

Question 18

What is a negative of a ileostomy?

Answer 18

It requires a permanent stoma

Question 19

What is a positive of an ileo-anal anastomosis?

Answer 19

Stoma reversal is possible and therefore there is a possibility of long-term continence

Question 20

What organs do UC complications affect?

Answer 20

Liver, Colon, Skin, Joints, Eyes

Question 21

What would you see under the microscope?

Answer 21

Mucosa only, crypt abscesses, depleted goblet cells

Question 22

What are risk factors for UC?

Answer 22

FH, NSAIDs, Chronic stress + depression

Question 23

What is a protective factor against UC?

Answer 23

Smoking

Question 24

What colon complications can occur?

Answer 24

Blood loss, perforation, toxic dilatation, colorectal cancer

Question 25

What skin complications can occur?

Answer 25

Erythema nodosum, pyoderma gangrenosum

Question 26

What joint complications can occur?

Answer 26

Ankylosing spondylitis, Arthritis

Question 27

What eye complications can occur?

Answer 27

Iritis, uveitis, episcleritis

Question 28

What liver complications can occur?

Answer 28

Fatty change, chronic pericholangitis, sclerosing cholangitis

Question 29

What liver biochemistry might change in severe disease?

Answer 29

Hypoalbuminaemia

Question 30

What antibody might be positive in UC but not in Crohn’s?

Answer 30

pANCA

Question 31

What organisms should you exclude using stool samples?

Answer 31

C.diff, campylobacter

Question 32

What would you expect faecal calprotectin to be?

Answer 32

Raised in all IBD

Question 33

What is the gold standard investigation?

Answer 33

Colonoscopy and biopsy

Question 34

Why would you do an AXR?

Answer 34

To exclude colonic dilatation

Question 35

What are some commonly prescribed 5-ASAs?

Answer 35

Sulfasalazine, mesalazine, olsalzine

Question 36

Is mucus in stool in UC or CD?

Answer 36

UC

Question 37

What is a side effect of sulfasalazine?

Answer 37

Haemolytic anaemia