Ulcerative colitis

Question 1

Define Ulcerative colitis

Answer 1

Inflammatory bowel disease-AID
Involves the rectum and sigmoidal colon
Diffuse inflamation of the colon,NOT patchy, relapsing course

Question 2

Aetiology of Ulcerative colitis

Answer 2

Unkown for sure, but part genetic, part autoimmune, part environment
Involves mucosa (not full depth) of colon/rectum-crypt abscesses and mucin depletion-inflam of crypt of liebrekhun

risk factors;
SMOKING is protective
Age-young 20-30, 2nd peak at 60
White(northern Europe)
FHx of IBD
Infection linked to relapses

Question 3

Epidiemology of Ulcerative colitis

Answer 3

around 20 cases per 100000 in world, but 1 in 1000 north Europe

Question 4

Signs and Sx of Ulcerative colitis

Answer 4

Diarrhoea (severity and frequency linked to severity of disease)
Blood stools
Rectal bleed (esp on DRE)

also often abdominal pain and tenderness
possible arthritis
Malnutrition, weight loss
Erythema nodosum
failure to thrive in children

Question 5

Investigations of Ulcerative colitis

Answer 5

Stool studies-no occult blood (should be very visible), No C.diff
WCC in stool, Faecal calprotectin high

FBC-aneamia, leukocytoss
CRP high
AXR-can show dilated loops, fingerprinting (sign of inflammation), lead piping or toxic megacolon

Endoscopy is goldstandard diagnostic tool (with biopsieis)-easy to see in colon, and can assess how far it goes

Question 6

Management of Ulcerative colitis

Answer 6

2 goals-induce remission during crisises, and then maintain remission

1st line crisis-Anal mesasalazine, with steroids

Mild UC remission-mesalazine, beclamethasone

then Azathriprine (if steroids not enough/need too high of dose)-good for keeping remission

then biotherapies-TNFa inhib-infliximab

and if needed-surgery can be curative

Question 7

Complications of Ulcerative colitis

Answer 7

Toxic megacolon-esp in fulimnant disease

perforation->sepsis

massive bleeds (rarer, but dangerous)

High risk of dysplasia-cancer chance increase with severity and extent of disease
surveillance colonoscopy 5-10 years after start of disease

Infections are common causes of relapse

Education key for malnutrition and oesteoporosis

Big risk factor for primary Sclerosis cholangitis-need LFT’s often to check for that

Question 8

prognosis of Ulcerative colitis

Answer 8

Does not seem higher than in general population
most common cause of death is toxic megacolon

having surgery increases chance of death
cancer in 3-5% of pt
monitor growth in children