Ulcerative colitis Flashcards
define UC?
chronic relapsing and remitting inflammatory disease affecting the large bowel
where does UC most commonly affect?
rectum
doesn’t spread beyond the ileocecal valve
how does UC pattern?
it is continuous
what are the risk factors for UC?
Possible genetic susceptibility
what might trigger flare ups of UC?
stress
NSAIDs
antibiotics
cessation of smoking
what is UC often associated with?
- Primary sclerosing cholangitis
which groups is UC more common in?
o Ashkenazi jews
o Caucasians
• Uncommon before the age of 10 yrs
• Peak onset: 15-25 and 55-65
presenting symptoms of UC?
- Bloody or mucous diarrhoea
- Tenesmus and urgency
- Crampy abdominal pain before passing stool
- Weight loss
- Fever
- Extra-GI manifestations
what are the signs of UC on physical examination?
- Signs of iron deficiency anaemia
- Dehydration
- Clubbing
- Abdominal tenderness
- Tachycardia
- Blood, mucus and tenderness on PR examination
- Extra-GI manifestations
what might the bloods show?
o FBC: • Low Hb • High WCC o High ESR or CRP o Low albumin
what might a stool sample show?
o Infectious colitis is a differential diagnosis so a stool culture maybe useful
o Faecal calprotectin allows differentiation of IBS from IBD
what will an AXR rule out?
o Rule out toxic megacolon
what are the features of toxic megacolon?
transverse colon >6cm in diameter
what will a colonoscopy show?
o Determines severity
o Histological confirmation
o Detection of dysplasia
what feature might a barium enema show?
o Loss of haustral pattern – lead-pipe appearance
what is mild UC ?
< 4 stools/day only a small amount of blood
No systemic features
what is moderate UC ?
4-6 stools/day
varying amounts of blood
no systemic upset
what is severe UC?
>6 bloody stools per day Blood in stools At least one of the following: Temp>37.8 HR >90 bpm Anaemia >105g/L ESR >30mm/hour
how to manage an acute severe exacerbation?
o Admission to hospital
o IV rehydration
o IV corticosteroids
o No improvement after 72 hours – add ciclosporin or consider surgery
how to treat toxic megacolon?
proctocolectomy
when does the patient need immunosuppression?
o If a patient has a severe relapse or >2 relapses in a year they need immunosuppression
how to manage moderate disease?
o Rectal 5-ASA derivatives and high dose oral 5-ASA derivative
o If remission is not achieved in 4 weeks, offer high dose 5-ASA derivatives and oral corticosteroid.
o Immunosuppression
how to manage mild disease?
o rectal 5-ASA derivatives
o add oral 5-ASA derivative after 4 weeks
o add topical or oral corticosteroid
o if extending past left sided colon treat as moderate
how to advice the patient?
o Patient education and support
o Treat complications
o Regular colonoscopic surveillance
what are the surgical interventions?
- Proctocolectomy with ileostomy
* Ileo-anal pouch formation
GI complications of UC?
o Haemorrhage o Toxic megacolon o Perforation o Colonic carcinoma o Gallstones o Primary sclerosing cholangitis
extra GI complications of UC?
o Uveitis o Renal calculi o Arthropathy o Sacroiliitis o Ankylosing spondylitis o Erythema nodosum o Pyoderma gangrenosum o Osteoporosis (from chronic steroid use) o Amyloidosis
prognosis of UC?
• Normal life expectancy • Poor prognostic factors: o Low albumin (< 30 g/L) o PR blood o Raised CRP o Dilated loops of bowel o 8+ bowel movements per day o Fever
