Ulcerative Colitis

Question 1

Epidemiology of ulcerative colitis

Prevalence? age? F:M?

Answer 1

100-200 /100,000
30s
F>M

Question 2

Causes of ulcerative colitis

Answer 2

Concordance = 10%
TH2-mediated

Note: Smoking protective

Question 3

Macroscopic changes of ulcerative colitis

Answer 3

• Rectum + colon ± backwash ileitis ulcers,
• Contiguous
• no strictures

Question 4

Microscopic changes in ulcerative colitis

Answer 4

• Mucosal or Crypt Abscesses inflammation
• shallow and broad ulcers
• marked pseudopolyps

Question 5

Symptoms of ulcerative colitis

Answer 5

• Diarrhoea
• Blood ± mucus PR
• Abdominal discomfort
• Tenesmus, faecal urgency

Question 6

Abdominal Signs of ulcerative colitis

Answer 6

• fever

- tender, bloated

Question 7

Blood investigations for ulcerative colitis

Answer 7

• FBC: ↓Hb, ↑WCC
• LFT: ↓albumin
• ↑CRP/ESR
• Blood cultures

Question 8

Stool investigations for ulcerative colitis

Answer 8

• MCS: exclude Campy, Shigella, Salmonella…

- CDT: C. diff may complicate or mimic

Question 9

Imaging investigations for ulcerative colitis

Answer 9

1. AXR: megacolon (>6cm), wall thickening
2. CXR: perforation
3. Ba / gastrograffin enema
4. illeocolonoscopy + regional biopsy

Question 10

Complications of ulcerative colitis?

Answer 10

1. toxic megacolon
2. bleeding
3. malignacny (CRC or cholangiocarcinoma)

Question 11

Ba enema findings for ulcerative colitis?

Answer 11

• Lead-pipe: no haustra
• Thumbprinting: mucosal thickening
• Pseudopolyps

Question 12

Management of Severe ulcerative colitis?

Answer 12

1. Resus: IV hydration, Nil by mouth

2. Hydrocortisone: IV 100mg QDS + PR

Question 13

If no improvement after the initial management of severe ulcerative colitis attack, what is the treatment?

Answer 13

• On day 3, stool freq >8 or CRP >45 predicts 85% chance of colectomy
• ciclosporin, infliximab or visilizumab (anti-T cell)
• consider Surgical options

Question 14

Secondary management of severe ulcerative colitis after improvement post-primary care?

Answer 14

• Switch to oral pred + a 5-ASA

- Taper pred after full remission

Question 15

Overview of management of crohns

Answer 15

1. Inducing remission in mild/mod disease (outpatient-based)
2. Oral therapy
3. topical for more left sided disease (eg suppositories)

Question 16

Oral therapy for ulceratice colitis

Answer 16

• 1st line: 5-ASAs (eg sulfasalazine)

- 2nd line: prednisolone

Question 17

Drugs for maintaining remission in ulceratice colitis

Answer 17

1st line: 5-ASAs PO – sulfasalazine or mesalazine (Topical Rx may be used in proctitis)
2nd line: Azathioprine or 6-mercaptopurine
3rd line: Infliximab / adalimumab

Question 18

how many ulceratice colitis pts need surgery?

Answer 18

• 20% require surgery at some stage

- 30% ̄c colitis require surgery w/i 5yrs

Question 19

Indications for emergency surgery in ulceratice colitis

Answer 19

• Toxic megacolon
• Perforation
• Massive haemorrhage
• Failure to respond to medical Rx

Question 20

Emergency surgical options available to ulceratice colitis patients?

Answer 20

1. Total / subtotal colectomy ̄c end ileostomy ± mucus fistula
   + 2. Followed after ~3mo by either
   a. Completion proctectomy + Ileal-pouch anal
   anastomosis (IPAA) or end ileostomy
   b. Ileorectal anastomosis (IRA)
2. Panproctocolectomy + permanent end ileostomy

Question 21

Elective surgery indications for ulceratice colitis?

Answer 21

• Chronic symptoms despite medical therapy

- Carcinoma or high-grade dysplasia

Question 22

Abdominal complications of surgery on ulceratice colitis?

Answer 22

• SBO
• Anastomotic stricture
• Pelvic abscess

Question 23

Stoma complications of surgery on ulceratice colitis?

Answer 23

retraction, stenosis, prolapse, dermatitis

Question 24

Pouch complications of surgery on ulceratice colitis?

Answer 24

• Pouchitis (50%)
• ↓ female fertility
• Faecal leakage