Ulcerative Colitis

Question 1

Description: Briefly describe what ulcerative colitis involves

Answer 1

Continuous inflammation, that is worst distally and rectum is almost always involved

Question 2

Aetiology/ Risk factors: What is the main cause of ulcerative colitis?

Answer 2

Cause:

- Inappropriate and persistent activation of the mucosal immune system

Question 3

Pathology: Describe the pathology and histology of ulcerative colitis. (9)

Answer 3

• Only the large colon affected
• Only mucosa and submucosa affected
• Continuous inflammation
• Starts at the rectum and may go proximal
• Formation of pseudopolyps
• Cryptitis and crypt abscesses
• No granulomas
• Fibrosis of submucosa
• Goblet cell depletion

Question 4

Pathology: Describe how ulcerative colitis can develop into cancer. (3)

Answer 4

• Flat epithelial atypia to adenomatous change to invasive cancer

Question 5

Symptoms: State the symptoms of ulcerative colitis that a patient would present with. (4)

Answer 5

• Bloody diarrhoea
• Abdominal pain
• Weight loss
• Fatigue

Question 6

Signs: What are the markers of severe attack in ulcerative colitis

Answer 6

• Fever (> 37.5)
• Albumin (<30g/L)
• Tachycardia (90/min)
• Anaemia (<10g/dL)
• Leucocytosis, thrombocytosis
• ESR (CRP) is raised

Question 7

Signs: What are the extra-intestinal manifestations of ulcerative colitis? Include the organs involved (4) and the specific symptoms for each (3/4/3/3)

Answer 7

Extra – intestinal manifestations/signs:
SKIN:
- Vasculitis 
- Erythema nodosum 
- Pyoderma gangrenosum

LIVER AND BILIARY TREE:

• Gallstones
• Fatty liver
• Sclerosing cholangitis
• Pericholangitis

EYES:

• Episcleritis
• Conjunctivitis
• Uveitis

JOINTS:

• Ankylosing spondylitis
• Sacroiliitis
• Monoarticular arthritis

Question 8

Investigations: What investigations are done for ulcerative colitis?

(a) Blood tests (5)
(b) Stool studies (2)
(c) Other investigations (1)

Answer 8

Blood tests:

• ESR and CRP (high)
• Platelet count (high)
• White cell count (high)
• Haemoglobin (low)
• Albumin (low)

Stool studies:

• Stool culture to rule out infection
• Faecal calprotectin (> 200 = elevated)
• Colonoscopy with biopsy (surveillance colonoscopy to check for colon carcinoma)

Question 9

Treatment: How do we treat ulcerative colitis?

Answer 9

• 5ASA (Aminosalicyclates) - to maintain remission
• Steroids (prednisolone 40mg/day) - to induce remission
• Immunomodulators (azathioprine/ methotrexate)
• Biologics (monoclonal antibodies)
• Surgery

Question 10

Complications: What are the complications of ulcerative colitis? (4)

Answer 10

• Haemorrhage
• Perforation
• Toxic megacolon
• Colon cancer