Chapter 50: IBD- Ulcerative Colitis

Question 1

Incidence?

Answer 1

10/100,000

Question 2

At-risk population

Answer 2

• High in the Jewish population
• low in the African American population
• Positive family history in 20% of cases

Question 3

Sex?

Answer 3

Male > female

Question 4

Distribution?

Answer 4

Bimodal distribution at

• 20 to 35 and
• 50 to 65 years of age

Question 5

Initial symptoms

Answer 5

Bloody diarrhea (hallmark)

fever

weight loss

Question 6

Anatomic distribution

Answer 6

Colon only

Question 7

Route of spread

Answer 7

Almost always involves the rectum and spreads proximally always in acontinuous route without “skip areas”

Question 8

What is “backwash” ileitis?

Answer 8

Mild inflammation of the terminal ileum in ulcerative colitis; thought to be “backwash” of inflammatory mediators from the colon into the terminal ileum

Question 9

Bowel wall involvement

Answer 9

Mucosa/submucosa only

Question 10

Anal involvement

Answer 10

Uncommon

Question 11

Rectal involvement

Answer 11

100%

Question 12

Mucosal Findings

Answer 12

• Granular, flat mucosa
• Ulcers
• Crypt abscess
• Dilated mucosal vessels
• Pseudopolyps

Question 13

Diagnositc tests

Answer 13

• Colonoscopy
• barium enema
• UGI with small bowel follow through (to look forCrohn’s disease)
• stool cultures

Question 14

Complications

Answer 14

• Cancer
• toxic megacolon
• colonic perforation
• hemorrhage
• strictures
• obstruction
• complications of surgery

Question 15

Cancer risk

Answer 15

• ≈5% risk of developing colon cancer at 10 years;
• then, risk increases ≈1% per year;
• thus, an incidence of ≈20% after 20 years of the disease (30% at 30 years)

Question 16

Indications for surgery

Answer 16

• Toxic megacolon
  
  • (refractory to medical treatment);
• cancer prophylaxis
• massive bleeding
• failure of child to mature because of disease and steroids
• perforation
• suspicion of or documented cancer
• acute severe symptoms refractory to medical treatment
• inability to wean off of chronic steroids
• obstruction
• dysplasia
• stricture

Question 17

What are the common surgical options for ulcerative colitis?

Answer 17

1. Total proctocolectomy, distal rectal mucosectomy, and ileoanal pull through
2. Total proctocolectomy and Brooke ileostomy

Question 18

What is “toxic megacolon”?

Answer 18

• Toxic patient: sepsis, febrile, abdominal pain
• Megacolon: acutely and massively distended colon

Question 19

24-year-old man with ulcerative colitis receives Lomotil® for excessive diarrhea and develops fever, abdominal pain and tenderness, and a massively dilated colon on abdominal x-ray

Answer 19

Toxic megacolon

Question 20

28-year-old man with nonbloody diarrhea, low-grade fever,abdominal pain, perirectal abscesses, perianal fistulae

Answer 20

Crohns