Ulcerative colitis

Question 1

What is UC

Answer 1

• relapsing + remitting inflammatory disorder of colonic mucosa

Question 2

How common is it

Answer 2

• 1-2 in 1000

- x3 more common in non-smokers

Question 3

Who does it affect

Answer 3

• 15-30years

- M=F

Question 4

What are the causes/aetiology

Answer 4

• Unknown

- Genetic = 1 in 4 UC have FHx

Question 5

What is the pathophysiology of UC

Answer 5

• PROCTITIS = just rectum (~50%)
• L-SIDED COLITIS = part of colon (~30%)
• PANCOLITIS = entire colon (~20%)
• INFLAMMATION –> Hyperaemic/haemorrhagic granular colonic mucosa + pseudopolyps
• Punctate ulcers may extend deep into lamina propria –> usually NOT transmural

Question 6

What are the symptoms of UC

Answer 6

• Gradual onset diarrhoea (+/- blood + mucus)
• Crampy abdo pain
• Bowel freq rel to sev
• Fever, malaise, anorexia, weight loss
• Urgency, tenesmus in rectal disease

Question 7

What are the (extra-intestinal) signs for UC

Answer 7

• may be none
• tachycardia, fever, tender, distended stomach

EXTRA-INTESTINAL SIGNS

• Clubbing
• apthous ulcers
• erythema nodosum (red lump on shins)
• iritis
• pyoderma gangrenosum (necrotic ulcers on leg)
• conjunctivitis
• nutritional def

Question 8

What are the DDx

Answer 8

• Crohns
• Indeterminate/ radiation / infectious/ Ischaemic colitis
• Diverticulitis
• IBS
• Vasculitis

Question 9

What investigations are there for UC

Answer 9

• Bloods - FBC, ESR, CRP, LFT, U&E, blood culture
• Stool MC+ (exclude infection)
• AXR - no faecal shadows, mucosal thickening/islands = “THUMB PRINTING”
• Sigmoidoscopy
• Rectal biopsy
• Colonoscopy - show extent of disease

Question 10

What is the management/ Tx for UC

Answer 10

• Mild = prednisolone
• Mod = pred + 5-ASA e.g.mesalazine + sulphasalazine
• Sev = ciclosporin/ infliximab + hydrocortisone (IV + Rectal), hydration
• 20% require surgery = proctocolectomy + temrinal ileostomy