Ulcerative Colitis

Question 1

Describe the environmental factors involved In ulcerative colitis

Describe the genetic factors involved in ulcerative colitis

Answer 1

Smoking => 40% risk REDUCTION
Appendicectomy => protective

Increase risk
Enteric infections
Isotretinoid (acne)
ABx
Diet => simple sugars, urbanisation, microparticles and preservatives

Polygenic

Question 2

What is ulcerative colitis
Describe the pathophysiology

What are the main symptoms

Answer 2

Superficial mucosal inflammation extending proximally from rectum
-exaggerated mucosal T cell response to microbiome, ext stimuli

Rectal bleeds and diarrhea => dehydration
Urgency
Minimal abdo pain or nutritional deficiency (due to superficial involvement)
-tender

Question 3

Describe the epidemiology of ulcerative colitis

Answer 3

Increased incidence in developed countries
No gender bias

Increased onset in 20s, 30s and 50s

Question 4

How would you diagnose UC

Answer 4

Blood tests

• high CRP, ESR
• microcytic anemia due to Fe deficiency from blood loss
• low albumin due to loss of protein from bowel lining => using up albumin in the body

Stool test

• high calprotectin => marker of inflammation in GI
• MC&S, CDiff

CXR
AXR => toxic megacolon (swollen, thinned)

Sigmoidoscopy => take biopsies, assess severity
-crypt abscess, mucosal inflammation

Question 5

How would you classify UC

Answer 5

Rectum only => proctitis
Left sided => colitis
Large bowel => pancolitis

Can measure amount of inflammation in cm

Question 6

How would you treat UC

Answer 6

Acute exacerbations, maintenance of remission

• steroids (PO-prednisolone, IV-hydrocortisone)
• aminosalicylates (PO, PR-mesalazine)

Immunosuppressants => thiopurines like azathiopurine, methotrexate, ciclosporin
Biologics => gives bowel time to heal
-TNFa => infliximab, adalimumab, golimumab, certolizumab pegol
-anti integrin => vedolizumab
-JAK inhibitors => tofacitinib

LMWH => inflammation is highly thrombogenic

Question 7

What is the surgical pathway for ulcerative colitis
How would you decide when to operate
How long does this take?

Answer 7

Day 3 of admission to decide on rescue therapy or surgery

Proctocolectomy => remove entire colon

• no more symptoms linked to UC
• leads to stoma formation, rectum removal

Ileal J pouch to form an anal anastomoses
-keep stoma until rectum has healed => remove stoma

Whole process takes around a year

Question 8

How would you judge when to admit a patient with UC

Answer 8

Truelove & Witt criteria

-admit if they meet 2+ severe criteria