Ulcerative colitis

Question 1

define UC?

Answer 1

chronic relapsing and remitting inflammatory disease affecting the large bowel

Question 2

where does UC most commonly affect?

Answer 2

rectum

doesn’t spread beyond the ileocecal valve

Question 3

how does UC pattern?

Answer 3

it is continuous

Question 4

what are the risk factors for UC?

Answer 4

Possible genetic susceptibility

Question 5

what might trigger flare ups of UC?

Answer 5

stress
NSAIDs
antibiotics
cessation of smoking

Question 6

what is UC often associated with?

Answer 6

• Primary sclerosing cholangitis

Question 7

which groups is UC more common in?

Answer 7

o Ashkenazi jews
o Caucasians
• Uncommon before the age of 10 yrs
• Peak onset: 15-25 and 55-65

Question 8

presenting symptoms of UC?

Answer 8

• Bloody or mucous diarrhoea
• Tenesmus and urgency
• Crampy abdominal pain before passing stool
• Weight loss
• Fever
• Extra-GI manifestations

Question 9

what are the signs of UC on physical examination?

Answer 9

• Signs of iron deficiency anaemia
• Dehydration
• Clubbing
• Abdominal tenderness
• Tachycardia
• Blood, mucus and tenderness on PR examination
• Extra-GI manifestations

Question 10

what might the bloods show?

Answer 10

o	FBC: 
•	Low Hb 
•	High WCC 
o	High ESR or CRP 
o	Low albumin

Question 11

what might a stool sample show?

Answer 11

o Infectious colitis is a differential diagnosis so a stool culture maybe useful
o Faecal calprotectin allows differentiation of IBS from IBD

Question 12

what will an AXR rule out?

Answer 12

o Rule out toxic megacolon

Question 13

what are the features of toxic megacolon?

Answer 13

transverse colon >6cm in diameter

Question 14

what will a colonoscopy show?

Answer 14

o Determines severity
o Histological confirmation
o Detection of dysplasia

Question 15

what feature might a barium enema show?

Answer 15

o Loss of haustral pattern – lead-pipe appearance

Question 16

what is mild UC ?

Answer 16

< 4 stools/day only a small amount of blood

No systemic features

Question 17

what is moderate UC ?

Answer 17

4-6 stools/day
varying amounts of blood
no systemic upset

Question 18

what is severe UC?

Answer 18

>6 bloody stools per day
Blood in stools At least one of the following: 
Temp>37.8 
HR >90 bpm 
Anaemia >105g/L
ESR >30mm/hour

Question 19

how to manage an acute severe exacerbation?

Answer 19

o Admission to hospital
o IV rehydration
o IV corticosteroids
o No improvement after 72 hours – add ciclosporin or consider surgery

Question 20

how to treat toxic megacolon?

Answer 20

proctocolectomy

Question 21

when does the patient need immunosuppression?

Answer 21

o If a patient has a severe relapse or >2 relapses in a year they need immunosuppression

Question 22

how to manage moderate disease?

Answer 22

o Rectal 5-ASA derivatives and high dose oral 5-ASA derivative
o If remission is not achieved in 4 weeks, offer high dose 5-ASA derivatives and oral corticosteroid.
o Immunosuppression

Question 23

how to manage mild disease?

Answer 23

o rectal 5-ASA derivatives
o add oral 5-ASA derivative after 4 weeks
o add topical or oral corticosteroid
o if extending past left sided colon treat as moderate

Question 24

how to advice the patient?

Answer 24

o Patient education and support
o Treat complications
o Regular colonoscopic surveillance

Question 25

what are the surgical interventions?

Answer 25

* Proctocolectomy with ileostomy | * Ileo-anal pouch formation

Question 26

GI complications of UC?

Answer 26

``` o Haemorrhage o Toxic megacolon o Perforation o Colonic carcinoma o Gallstones o Primary sclerosing cholangitis ```

Question 27

extra GI complications of UC?

Answer 27

``` o Uveitis o Renal calculi o Arthropathy o Sacroiliitis o Ankylosing spondylitis o Erythema nodosum o Pyoderma gangrenosum o Osteoporosis (from chronic steroid use) o Amyloidosis ```

Question 28

prognosis of UC?

Answer 28

``` • Normal life expectancy • Poor prognostic factors: o Low albumin (< 30 g/L) o PR blood o Raised CRP o Dilated loops of bowel o 8+ bowel movements per day o Fever ```