UC

Question 1

Definition

Answer 1

Relapsing remitting idiopathic inflammatory condition of colonic mucosa. Common in rectum. Expands proximally.
Pan colitis and backwash ileitis
Continuous pattern. Mucosal inflammation.
Extra intestinal problems in both IBDs-
arthritis
skin eg erythema nodosum, pyoderma gangrenosum, psoriasis.
Primary sclerosing cholangitis.
Eye problems.

Question 2

Aetiology

Answer 2

Unknown.
Some genetic susceptibility. Likely AI triggered by colonic bacteria.
Hyperaemic colonic mucosa possibly with inflammatory pseudopolyps. TH2 production of TGF and IL5.
Puctate ulcers into lamina propria.
Not transmural.
Possibly gut organism altered interaction.
Triggers possibly AB, infection, diet.
Smoking makes better.

Question 3

Symptoms

Answer 3

Episodic or chronic diarrhoea possibly with blood and mucous.
Colicky abdo pain, not very severe. Tender, distended.
Urgency or tenesmus
Systemic symptoms during attacks- fever, malaise, anorexia, weight loss.
Eye pain and inflammation.

Question 4

Signs

Answer 4

Possibly none. 
In acute sever- fever, tachy, tender distended abdo. 
Clubbing
Ulcer
Erythema nodosum
Conjunctivitis, iritis
Arthritis 
Ankylosing spondylitis
Fatty liver
CholangioCA
Amyloidosis
Pyoderma gangrenosum
Thrombosis
Chronic gastritis 
Toxic megacolon
Sclerosing cholangitis
Crypt abcesses
Linear ulcerations.

Question 5

Differentials

Answer 5

Crohns
IBS
Protozoa or parasite
Neoplasm
Ischaemic bowel disease
Diverticulitis
Polyposis, colon polyps 
Rectal ulcer
Acute self limiting colitis
Drugs eg chemo, NSAIDs.

Question 6

Management

Answer 6

Stepwise:
Nutrition
Topical 5-aminosalicyclates- rectal or oral, for flare and remission, eg sulfasalazine, mesalazine.
Oral CS if severe eg prednisolone for flares only.
Immunomodulators eg azathioprine.
Oral tacrolimus T inhibitor.
Anti TNF eg infliximab
New mAbs.
Surgery can cure- do if inflammation not settle, preCA change, toxic megacolon.

Question 7

Pathology

Answer 7

CI filtrate of lamina propria. 
Crypt abcesses and distortion. 
Less goblet cells.
Pseudopolyps. 
Loss haustra. 
Friable mucosa.

Question 8

Investigation

Answer 8

Bloods- anaemia, serum markers. FBC, CRP, ESR, UE, LFT, Fe, B12, culture.
Stool culture
AXR lead pipe or spotty inflammation, mucosal thickening. Also exclude dilation.
Barium enema
CT or MRI
Colonoscopy/sigmoidoscopy with biopsy- infiltrate, goblet depletion, mucosal ulcer, crypt abcess.

Question 9

Complications

Answer 9

Perforation=peritonitis, sepsis
Bleeding
Toxic dilation
Venous thrombosis
Colorectal CA big risk
Psychological and sexual dysfunction

Question 10

Anti proliferative immunosuppressant eg Azathioprine

Answer 10

Inhibits purine metabolism once cleaved to 6-MP.
IBD maintenance tx.
AE- bm suppression, neutropenia, high risk malignancy and infection, hepatitis.
Monitor FBC and LFT
Test for TPMT metabolising enzyme levels first

Question 11

Sulfasalazine

Answer 11

T cell and neutrophil inhibition.
Some efficacy in IBD
safe in pregnancy.
AE- rash, low sperm count, mouth ulcer, fatigue, myelosuppression, heapatitis, nausea, headache.

Question 12

Explanation

Answer 12

• UC happens when you get inflammation of your large bowel which is involved in water absorption. The inflammation causes damage to the lining and wall of the bowel, causing pain and diarrhoea.
• it will often come in phases. If left alone it can cause complications like ulcers and cancer. Also bleeding, perforation, dilation.
• lifestyle requires good nutrition.
• medical treatment includes tablets to prevent the immune system from causing the inflammation. Surgery can be an option down the line if these things dont work.