Ulcerative Colitis (IBD)

Question 1

Superficial (layers of the bowel and intestine) inflammatory bowel disease that involves primarily the rectum and colon

Answer 1

Ulcerative colitis

Question 2

Involves ___-___ per 100,000 people per year

Answer 2

10-12

Question 3

Lesions appear between the ages of ___-___

Answer 3

20-40

Question 4

More frequent in which two races?

Answer 4

Caucasians

Ashkenazi Jews

Question 5

Environmental factors to ulcerative colitis development (2)

Answer 5

1. Infectious microbial agents that cause inflammation

2. Diet?

Question 6

Genetic factor that relate to UC development

Answer 6

13x increased risk if first-degree relative is diagnosed

Question 7

Other factors that relate to UC development (2)

Answer 7

1. REDUCED risk in smokers (weird)

2. People who had appendectomy before 20

Question 8

What is the trigger for UC?

Answer 8

Inflammatory reaction from possibly an environmental agent or microbe induced T cell stimulation

Question 9

What immunologic evidence is present that UC is an autoimmune disorder? (5)

Answer 9

1. Bowel wall infiltrated with WBCs
2. Systemic manifestations outside of intestines
3. Often accompanied by other autoimmune disease
4. Attacks respond to immunosuppressive drugs
5. Excessive TH2 cell activity that stimulates B cells that produce antibodies against colon proteins

Question 10

Where is the starting location for UC?

Answer 10

Begins at rectum and spreads, where severity and spread have a direct correlation

Question 11

What is the main pathology of UC?

Answer 11

Continuous and superficial inflammation cause a massive over activation and recruitment of WBCs that attack surface tissues. These dead surface tissues then slough off and lead to erosions.

Question 12

What are pseudopolyps?

Answer 12

Certain areas of regenerating tissues that are trying to regrow in an area that is surrounded by dead tissue (erosions)

Question 13

UC has what type of disease pattern?

Answer 13

Relapsing and remitting

Question 14

What are common clinical presentations of UC? (10)

Answer 14

1. Bloody diarrhea
2. Increased BMs
3. Abdominal cramping/tenderness
4. Rectal bleeding
5. Fecal urgency
6. Anemia from excessive blood and fluid loss
7. Weakness
8. Fever
9. Hypokalemia from malabsorption and diarrhea
10. Low serum albumin

Question 15

Extraintestinal manifestations occur in ___% of patients

Answer 15

25%

Question 16

Extraintestinal signs of UC

Answer 16

1. Uveitis
2. Ankylosing spondylitis (curved spine)
3. Sclerosing cholangitis
4. Erythema nodosum (red skin splotches)
5. Malnutrition
6. Arthritis (can move to different locations over long period of time)
7. Pyoderma gangrenosum (Gang-green)

Question 17

How many bowel movement per day qualify for abnormal bowel movements?

Answer 17

More than 5 per day; UC patients can have between 10-20

Question 18

What are patient assessment tests for UC? (4)

Answer 18

1. Physical exam and med history
2. Stool cultures (rule out infection)
3. CBC (Increased WBCs); decreased serum albumin
4. Proctosigmoidoscopy/colonoscopy

Question 19

Which antibody is only increased in colitis and not Crohn’s disease, which is used to help differentiate the two conditions?

Answer 19

Anti-neutrophil cytoplasmic antibodies (ANCA)

Question 20

How much of the colon does a colonoscopy examine?

Answer 20

Entire length of colon

Question 21

How much of the colon does a sigmoidoscopy examine?

Answer 21

Lower third of colon

Question 22

Acute complications of UC (4)

Answer 22

1. Toxic megacolon
2. Anal fissures
3. Perirectal abscesses
4. Perforation

Question 23

Long-term complications of UC?

Answer 23

Colon cancer

Question 24

How often are patients with a history of UC recommended to get a screening?

Answer 24

Every 2 years