Ulcerative Collitus Flashcards
What is UC?
chronic relapsing + remitting inflammatory disease affecting the large bowel
How is UC disease extent divided?
Distal: colitis confined to rectum or rectum + sigmoid colon
Left-sided colitis: to splenic flexure
Extensive colitis: to hepatic flexure
Pancolitis: whole colon
Give 3 epidemiological facts about UC
Peak onset: 20-30s
2nd peak 50-60s
M:F
Prevalence increasing
Describe the aetiology of UC
Unknown- maybe AI condition triggered by colonic bacteria causing inflammation in GIT
Greater risk if FH present
Decreased risk in smokers
What is the cardinal symptom of UC?
Bloody diarrhoea
List 4 symptoms of UC
Colicky abdominal pain
Urgency/ Tenesmus
Weight loss
Fever
List 5 extra-GI manifestations of UC
Uveitis Scleritis Erythema nodosum Pyoderma gangrenosum Apthous ulcers
What may presentation of UC mimic?
Amoebic colitis
List 8 signs of UC on examination
Signs of IDA Dehydration Clubbing Abdominal tenderness/ distension/ masses Tachycardia Hypotension Blood, mucus + tenderness on PR Extra-GI manifestations
Describe bloods taken/ results for UC
FBC: Low Hb + High WCC High ESR/ CRP Low albumin U+Es LFTs: detect PSC
Why is a stool sample used in suspected UC?
Infectious colitis is a ddx so stool should be tested
Allows differentiation of IBS from IBD
What allows for differentiation between IBS and IBD? How? Why?
Faecal calprotectin
Is raised in inflammatory processes (IBD)
Both IBS + IBD can present with long-term diarrhoea
Why perform an abdominal x-ray in suspected UC?
May see Lead pipe colon
To exclude toxic megacolon
Why perform a Flexible Sigmoidoscopy or Colonoscopy (and biopsy) in suspected UC?
Determines severity
Histological confirmation
Detection of dysplasia
What is seen on a barium enema in UC?
Mucosal ulceration with granular appearance + filling defects (due to pseudopolyps)
Narrowed colon
Loss of haustral pattern (“leadpipe”)
Which investigations may be dangerous in acute exacerbation of UC? Why?
Colonoscopy + barium enema
Risk of perforation
List 6 markers of increased disease activity in UC
Decreased Hb Decreased albumin Increased ESR + CRP Diarrhoea frequency: < 4 = mild, 4-6 = moderate, 6+ = severe Bleeding Fever
Describe the management of acute exacerbations in UC
IV rehydration IV corticosteroids Antibiotics Bowel rest Parenteral feeding DVT prophylaxis
What is the patient likely to need if they have toxic megacolon? Why?
Proctocolectomy
Has high mortality
How is mild UC managed?
Oral/ rectal 5-ASA derivatives (e.g. mesalazine, olsalazine, sulphasalazine)
Corticosteroids to induce remission
How is moderate-severe UC managed?
Oral steroids
Oral 5-ASA
Immunosuppression (with azathioprine, cyclosporine, 6-mercaptopurine or infliximab (anti-TNF))
What must a doctor do when managing a UC patient?
Educate + support patient
Treat complications
Perform colonic surveillance regularly
When is surgery considered in treatment of UC?
If medical treatment fails
Presence of complications
To prevent colonic carcinoma
What surgical procedures can treat UC?
Proctocolectomy with ileostomy
Ileo pouch anal anastomosis
List 6 possible GI complications of UC
Haemorrhage Toxic megacolon Perforation Colonic carcinoma Gallstones PSC
List 3 possible extra-GI manifestations of UC
Arthropathy
Osteoporosis (from chronic steroid use)
Amyloidosis
What is the prognosis for patients with UC?
Unpredictable relapses + remissions
Near normal life expectancy
List 5 poor prognostic factors in UC
Severe symptoms at presentation Extensive disease Raised inflammatory markers <50 years esp. child-onset Poor compliance with drugs
What scoring system can be used to assess severity of UC?
Truelove + Witts Criteria
