Ulcerative Colitis

Question 1

Location

Answer 1

Restricted to the colon and rectum
Starts at the rectum and develops proximally
Proctitis - rectum only
Pancolitis - whole colon

Question 2

Age group

Answer 2

20-30

Males

Question 3

Histopathology

Answer 3

Continuous inflammation
Non-patchy 
No granulomas 
Crypt abscess
Superficial inflammation (mucosa, submucosa)

Question 4

Immunology

Answer 4

Mixed Th1 and Th2 disease

Question 5

Smoking aggrevates / is protective

Answer 5

Is protective

Question 6

Clinical presentation

Answer 6

Bloody diarrhoea 
Urgency 
Colicky abdominal pain (LIF)
Increased bowel frequency 
Tenesmus 
Pt wakes up at night with symptoms 
Incontinence 

Extra GI manifestations:
Erythema nodosum
Uveitis
Stomatitis

Question 7

Determining severity

Answer 7

> 6 bloody stools in 24 hrs + 1 or more of:

• fever
• tachycardia
• anaemia
• elevated ESR

Question 8

Investigations

Answer 8

Bloods
Plain AXR
Colonoscopy - biopsy

Question 9

Management

Answer 9

5ASA (mesalazine)
Steroids 
Immunosuppressant's (azathioprine) 
Anti TNF therapy 
Surgery - if no medications work

Question 10

Surgery

Answer 10

Very good outcomes
Patient is cured from disease
Stoma bag

Question 11

Genetics

Answer 11

NOD2

HLA DR2

Question 12

Associated conditions

Answer 12

PSC

Gallstones

Question 13

Complications

Answer 13

Colorectal cancer

Toxic megacolon