Ulcerative Colitis UC

Question 1

What is ulcerative colitis?

Answer 1

Ulcerative colitis (UC) is a chronic, relapsing-remitting inflammatory disease affecting the large bowel and rectum; it is the most common form of inflammatory bowel disease (IBD).

Question 2

At what ages is ulcerative colitis most commonly diagnosed?

Answer 2

UC has a bimodal distribution, with peaks at 15-30 years and 50-70 years.

Question 3

What are the proposed aetiological factors for ulcerative colitis?

Answer 3

The exact cause is unclear, but it involves altered intestinal microbiota and compromised colonic epithelial integrity, with genetic, environmental, and dietary factors playing roles.

Question 4

What are the risk factors for developing ulcerative colitis?

Answer 4

Family history of IBD, HLA-B27 positivity, recent gastrointestinal infection, NSAID use, smoking cessation, and Ashkenazi Jewish descent.

Question 5

What are the common gastrointestinal symptoms of ulcerative colitis?

Answer 5

Diarrhoea with or without blood and mucus, urgency, tenesmus, lower abdominal pain, abdominal discomfort, bloating, fatigue, weight loss, and malaise.

Question 6

What are some extra-intestinal manifestations of ulcerative colitis?

Answer 6

Iritis, uveitis, episcleritis, erythema nodosum, pyoderma gangrenosum, arthritis, osteoporosis, primary sclerosing cholangitis, nephrolithiasis, anaemia, and thromboembolism.

Question 7

What clinical examination findings might be present in a patient with ulcerative colitis?

Answer 7

Lower abdominal tenderness, abdominal distension, signs of anaemia, joint pain, clubbing, erythema nodosum, pyoderma gangrenosum, uveitis, and episcleritis.

Question 8

How is ulcerative colitis classified based on location and extent?

Answer 8

Proctitis (rectum), proctosigmoiditis (rectum and sigmoid colon), left-sided colitis (up to the splenic flexure), extensive colitis (beyond the splenic flexure), and pancolitis (entire colon).

Question 9

How is the clinical severity of ulcerative colitis categorized?

Answer 9

Mild, moderate, and severe, based on symptoms, inflammatory markers, and endoscopic findings.

Question 10

What are the differential diagnoses for ulcerative colitis?

Answer 10

Infectious colitis, Crohn’s disease, ischaemic colitis, radiation colitis, diverticulitis, vasculitis, and irritable bowel syndrome (IBS).

Question 11

What initial laboratory investigations are important in suspected ulcerative colitis?

Answer 11

Full blood count, inflammatory markers (CRP, ESR), liver function tests, renal function tests, and stool studies (including faecal calprotectin).

Question 12

What imaging studies are useful in the assessment of ulcerative colitis?

Answer 12

Abdominal X-ray, abdominal ultrasound, and CT scan, particularly in acute severe colitis to assess for complications like toxic megacolon.

Question 13

What endoscopic procedure is essential for diagnosing ulcerative colitis?

Answer 13

Colonoscopy with biopsy to assess the extent of inflammation and obtain histological confirmation.

Question 14

What histological features are characteristic of ulcerative colitis?

Answer 14

Continuous mucosal inflammation limited to the colon, crypt abscesses, and goblet cell depletion.

Question 15

What is the first-line medical treatment for mild to moderate ulcerative colitis?

Answer 15

Aminosalicylates (e.g., mesalazine) administered orally or rectally.

Question 16

What medications are used for inducing remission in moderate to severe ulcerative colitis?

Answer 16

Corticosteroids (e.g., prednisolone) and immunosuppressants (e.g., azathioprine).

Question 17

What biologic therapies are available for ulcerative colitis?

Answer 17

Tumour necrosis factor (TNF) inhibitors (e.g., infliximab) and integrin receptor antagonists (e.g., vedolizumab).

Question 18

When is surgical intervention indicated in ulcerative colitis?

Answer 18

In cases of refractory disease, dysplasia or cancer, and complications such as perforation or severe bleeding.

Question 19

What is the most common surgical procedure performed for ulcerative colitis?

Answer 19

Total proctocolectomy with ileal pouch-anal anastomosis (IPAA).

Question 20

What are potential complications of ulcerative colitis?

Answer 20

Severe bleeding, bowel perforation, toxic megacolon, malnutrition, venous thromboembolism, osteoporosis, and colorectal cancer.

Question 21

What is toxic megacolon, and how is it related to ulcerative colitis?

Answer 21

Toxic megacolon is an acute complication where there is a loss of normal tone of the colon, resulting in dilatation and an increased risk of perforation; it is generally more associated with ulcerative colitis.

Question 22

What is the significance of a “lead-pipe” appearance on imaging in ulcerative colitis?

Answer 22

A “lead-pipe” appearance on imaging indicates a loss of the normal haustral folds due to chronic colitis, often seen in ulcerative colitis.

Question 23

How does ulcerative colitis differ from Crohn’s disease?

Answer 23

Ulcerative colitis affects only the colon and rectum, involves continuous inflammation, and is limited to the mucosa, whereas Crohn’s disease can affect any part of the GI tract, has skip lesions, and involves transmural inflammation.