Describe ulcerative colitis?
- Most common form of IBD
- Caucasians, bimodal (15-25, 55-65), males and females equally
- Relapsing and remitting
What can a severe fulminant exacerbation of UC result in?
- Severe systemic upset
- Toxic megacolon
- Colonic perforation
- Death
What is pictured here?
- Histology of bowel segment in UC
- Shows non-granulomatous inflammation with crypt abscess
Describe the pathophysiology of ulcerative colitis?
- Interaction between genetic factors and environmental triggers
- Diffuse continual mucosal inflammation of the large bowel
- Inflammation of mucosa and submucosa
Risk factors for UC?
- Positive family history
- Smoking is PROTECTIVE against UC
What is backwash ileitis?
- Portion of distal ileum is affected by UC
- Ileocaecal valve is not competent
Describe the differences between UC and Crohns?
What are the clinical features of UC?
- Insidious onset
- Cardinal feature is bloody diarrhoea*
- Proctitis, PR bleeding, mucus discharge
- Systemic symptoms: malaise, anorexia, low-grade pyrexia
Describe the grading of UC?
- Truelove and Witt criteria
Describe the extra-intestinal manfiestations of UC?
- MSK
- Arthritis, clubbing
- Skin
- Erythema nodosum
- Eyes
- Episcleritis, anterior uveitis, iritis
- Hepatobilary
- Primary sclerosing cholangitis
What is PSC?
Chronic inflammation and fibrosis of the bile ducts
Differentials for UC?
- Crohns
- Chronic infections (TB, schistosomiasis, giardiasis)
- Mesenteric ischaemia
- Radiation colitis
Investigations into someone with suspected UC?
- FBC, U&Es, CRP, LFTs, clotting
- Faecal calprotectin
- Stool sample with microscopy and culture
- Colonscopy with biopsy (definitive diagnosis)
- AXR or CT (assess for perforation, toxic megacolon)
What are the AXR features of UC flares?
- Mural thickening and thumb printing
- Chronic cases:
- Lead pipe colon
Describe the management of UC?
- Avoid anti-motility agents as they can cause toxic megacolon
- Fluid resus, nutritional support, prophylactin heparin
- Induce remission:
- Corticosteroids and immunosuppressives
- Maintaining remission:
- 1st line: Immunomodulators
- Mesalazine, sulfasalazine
- 2nd line: Monoclonal antibody therapy
- 1st line: Immunomodulators
- Surgical management may be required
Describe the step wise approach for inducing remission in UC?
What are the indications for acute surgical treatment of UC?
- Disease refractory to medical management
- Toxic megacolon
- Bowel perforation
Describe the surgical management of UC?
- Total proloctocolectomy is curative
- Patient will require ileostomy
- Subtotal colectomy with preservation of the rectum
Complications of UC?
- Toxic megacolon
- Colorectal carcinoma
- Osteoporosis
- Pouchitis
Describe toxic megacolon as a complication of UC?
- Severe abdominal pain on presentation
- Distension, pyrexia, systemic toxicity
- Decompression of bowel is required due to perforation risk
