General: Ulcerative Colitis Flashcards
Outline the pathophysiology of Ulcerative Colitis.
IBD
Diffuse continual mucosal inflam of LI beginning in rectum spreading proximally, potentially affecting the entire LI
Inflam of mucosa and submucosa, crypt abscesses, goblet cell hypoplasia
Outline the aetiology of Ulcerative Colitis.
Unknown
Smoking is a protective factor
What are the signs/symptoms of Ulcerative Colitis?
Insidious onset
Bloody diarrhoea (more than crohns)
Proctitis = inflam of anus
PR bleeding
Mucus discharge
Increased frequency
Urgency of defecation
Tenesmus = constant feeling to empty bowels
Systemic = malaise, anorexia, low-grade fever
What are the extra-intestinal features of Ulcerative Colitis?
Musculoskeletal = enteropathic arthritis (sacroiliac and other large joints) or nail clubbing
Skin = Erythema nodosum (tender red/purple subcutaneous nodules, found on the patient’s shins)
Eyes = Episcleritis, anterior uveitis, or iritis
Hepatobiliary = Primary sclerosing cholangitis (chronic inflam and fibrosis of the bile ducts)
How would you investigate Ulcerative Colitis?
Bloods = FBC, U+Es, CRP, LFTs, clotting, albumin, CRP, WCC
Faecal calprotectin = NICE guidelines in pts with lower GI symptoms
Stool sample = microscopy, culture
Colonoscopy with biopsy (2 from 5 sites) (not in acute cases)
AXR = to determine is toxic megacolon or perforation has occurred
Barium studies = best to show lead-pipe
How would you manage Ulcerative Colitis?
Fluid resuscitation
Nutritional support
Prophylactic heparin
Hydrocortisone - help remission induction
Immunosuppression = mesalazine or azathioprine
Infliximab
Colonoscopic surveillance = pts with >10 years of disease
IBD-nurse specialists and patient support groups
Severe - Nil by mouth in prep for surgery
Surgery = pts with toxic megacolon, perforation, massive haemorrhage, failed medical treatment
Total proctocolectomy = require ileostomy
What are the complications of Ulcerative Colitis?
Toxic megacolon
Colorectal carcinoma
Osteoporosis
Pouchitis = inflammation of an ileal pouch
What features might help differentiate between Crohn’s and ulcerative colitis?
Crohns = cobblestone, anywhere in the GI tract, smoking increases risk, episodic
UC = transmural, distal ilium and proximal colon, smoking is a protective factor, mucus with stool, insidious onset
What is the wider differential diagnosis of a patient presenting with bloody diarrhoea?
Infectious = e.coli, salmonella, shigella, campylobacter
Ischaemia colitis
GI bleeding = AVMs, diverticulitis
Meds = NSAIDs, chemotherapy
Cancer
