Ulcerative Colitis Flashcards
What is UC?
A relapsing and remitting inflammatory disorder of the colonic mucosa
Where is UC limited to?
From rectum to ileocaecal valve
What causes UC?
An inappropriate immune response to colonic flora in genetically susceptible individuals
What can form in severe UC?
Pseudopolyps, ulcers
What feature of UC differentiates it from Crohn’s Disease?
Circumferential and continuous inflammation limited to mucosa, no skip lesions
What layer is underneath the mucosa?
Submucosa
What layer is underneath the submucosa and what makes up this layer?
Muscularis propria made up of circular and longitudinal muscle
What is the outer layer of the colon?
Serosa
What symptoms might someone with UC have?
Remissions and exacerbations, LLQ pain, abdominal cramps/discomfort, episodic or chronic diarrhoea +/- blood/mucus or urgency
When might a patient experience systemic symptoms?
During UC attacks
What systemic symptoms might a patient experience?
Fever, malaise, anorexia, wt loss
What signs might a patient have in acute, severe UC?
Fever, tachycardia, tender and distended abdomen
What extraintestinal signs might be present?
Clubbing, aphthous oral ulcers, nutritional deficits
What blood results would you see?
Raised WCC, platelets, CRP and ESR, potentially anaemia
How would you manage mild/moderate UC?
5-ASAs/Aminosalicylates + oral prednisolone if not responding
How would you manage severe UC?
IV hydrocortisone, ciclosporin, infliximab
What surgical option is there?
Colectomy
What is a negative of a ileostomy?
It requires a permanent stoma
What is a positive of an ileo-anal anastomosis?
Stoma reversal is possible and therefore there is a possibility of long-term continence
What organs do UC complications affect?
Liver, Colon, Skin, Joints, Eyes
What would you see under the microscope?
Mucosa only, crypt abscesses, depleted goblet cells
What are risk factors for UC?
FH, NSAIDs, Chronic stress + depression
What is a protective factor against UC?
Smoking
What colon complications can occur?
Blood loss, perforation, toxic dilatation, colorectal cancer
What skin complications can occur?
Erythema nodosum, pyoderma gangrenosum
What joint complications can occur?
Ankylosing spondylitis, Arthritis
What eye complications can occur?
Iritis, uveitis, episcleritis
What liver complications can occur?
Fatty change, chronic pericholangitis, sclerosing cholangitis
What liver biochemistry might change in severe disease?
Hypoalbuminaemia
What antibody might be positive in UC but not in Crohn’s?
pANCA
What organisms should you exclude using stool samples?
C.diff, campylobacter
What would you expect faecal calprotectin to be?
Raised in all IBD
What is the gold standard investigation?
Colonoscopy and biopsy
Why would you do an AXR?
To exclude colonic dilatation
What are some commonly prescribed 5-ASAs?
Sulfasalazine, mesalazine, olsalzine
Is mucus in stool in UC or CD?
UC
What is a side effect of sulfasalazine?
Haemolytic anaemia
