ulcerative colitis

Question 1

what is UC ?

Answer 1

a type of IBD

-it is a chronic relapsing remitting inflammatory disease that affects the large bowel and rectum

Question 2

UC is bimodal , at what ages ?

Answer 2

15-30 years

50-70 years

Question 3

what causes it ?

Answer 3

it is idiopathic,

• but some evidence suggests that the combination of altered intestinal microbiota and compromised colonic epithelial integrity results in non-sterile intestinal components being exposed to the underlying immunological tissue causes the inflammation
• strong genetic relevance ie Ashkenazi Jewish
• and more prevalence in developed countries

Question 4

what are the risk factors for UC ?

Answer 4

• female gender
• Fx of IBD
• HLA-B27 positive
• recent GI infection
• NSAIDs
• smoking cessation (smoking somehow reduces intensity of UC)
• being of Ashkenazi Jewish descent

Question 5

what does it mean to be HLA-B27 positive ?

Answer 5

human leukocyte antigen B27 is a protein that is found on the surface of white blood cells, they help the body’s immune system tell the difference between its own cells and foreign substances
> a positive result indicates you are at higher risk for developing autoimmune disease

Question 6

what are the main symptoms of UC ?

Answer 6

> > diarrhoea +/- blood +/- mucus

• urgency
• tenesmus
• lower abdominal pain
• abdominal discomfort and bloating
• fatigue
• weight loss
• malaise

Question 7

what are the extra-intestinal manifestations of UC ?

Answer 7

uveitis 
erythema nodosum, pyoderma gangrenosum 
arthritis, ankylosing spondylitis 
gallstones, primary sclerosing cholangitis 
anaemia and thromboembolism

Question 8

what would you find on clinical examination for someone with UC ?

Answer 8

• lower abdominal pain
• lower abdominal tenderness
• abdominal distension
• features of anaemia (mouth, eyes)
• joint pain
• clubbing
• pyoderma gangrenosum, erythema nodosum
• uveitis

Question 9

how would you investigate for UC ?

Answer 9

>bloods : 
FBC = anaemia, raised WWC 
U&Es 
CRP = elevated 
LFTs - hypoalbuminaemia 
pANCA = if PSC is suspected 

> stool tests :
raised faecal calprotectin (not in IBS)
microscopy and culture - important as it excludes infection

> imaging :
endoscopy - flexible sigmoidoscopy, sometimes a full colonoscopy may be required
CT or AXR as well to exclude acute presentation of toxic megacolon

Question 10

what is the 1st line treatment for UC ?

Answer 10

mesalazine (for mild to moderate UC)

this is an aminosalicylate

Question 11

what other treatments for UC ?

Answer 11

• prednisolone (corticosteroid)
• thiopurines eg azathioprine
• biologics - infliximab (anti-TNFalpha) .. all the ‘..mabs’

Question 12

when is surgery appropriate for UC ?

Answer 12

when UC cannot be controlled by optimal medical treatment or if severe complications occur

Question 13

what type of surgeries could a patient receive ?

Answer 13

colectomies !!! woooooo

subcolectomy - resection of only part of the colon
complete proctocolectomy - resection of the entire colon and rectum
restorative proctocolectomy - entire colon and rectum resected and a temporary loop ileostomy is put in place

Question 14

what are the complications of UC ?

Answer 14

toxic megacolon 
severe bleeding 
malnutrition 
bowel perforation 
and colorectal cancer is more likely to develop in 10+ year of UC