Ulcerative Colitis

Question 1

What is UC

Answer 1

One the 2 common types of inflammatory bowel disease

Question 2

What is the bi-modal distribution of UC

Answer 2

Ages between 15-25years and 55-65years

Question 3

what is the characteristic inflammatory pattern observed in UC

Answer 3

diffuse continual mucosal inflammation of the large bowel, beginning in the rectum and spreading proximally, potentially affecting the entire large bowel.

Question 4

what is backwash ileitis

Answer 4

A portion of the distal ileum can become affected in a small proportion of cases, termed ‘backwash ileitis’ (if the ileocaecal valve is not competent).

Question 5

what are the clinical features of UC

Answer 5

Bloody diarrhoea

Proctitis ( inflammation of the rectum)

PR bleeding

Mucus discharge

Question 6

What grading system is used to assess the severity of UC exacerbations

Answer 6

True love and Witt criteria

Question 7

What are the differentials of UC

Answer 7

Crohns

Chronic infections ( schistosomiasis, giardiasis and TB)

Mesenteric ischaemia

Radiation colitis

Question 8

What are the Lab tests you would order

Answer 8

Routine bloods - FBC, U&Es , CRP, LFTs, COAG

Faecal calprotectin

Stool sample

Question 9

What are the imaging modalities used to investigate UC

Answer 9

Gold standard - colonoscopy with biopsy
( macroscopic- friable muscosa )

Flexible sigmoidoscopy may be sufficient

Question 10

What are the imaging modalities used in acute exacerbations of UC

Answer 10

AXR

CT Abdo

Barium studies - toxic megacolons

Question 11

how would you manage UC

Answer 11

Refer to gastroenterologist who should start treatment

Anti-motility drugs, such as loperamide, should be avoided in acute attacks, as these can precipitate toxic megacolon

Question 12

How would you induce remission of UC

Answer 12

Same as crohns

Question 13

What is the NICE guidelines on inducing remission for mild to moderate UC

Answer 13

Topical mesalazine or sulfasalazine

Add oral prednisolone + oral tacrolimus

Question 14

According to NICE guidelines, how would you treat mid to moderate UC with extensive inflammation

Answer 14

High oral dose mesalazine or sulfasalazine

Add oral prednisolone + oral tacrolimus

Question 15

According to NICE how do you treat severe UC

Answer 15

Intravenous corticosteroids and assess the need for surgery

Add infliximab if no short-term response

Question 16

How do you maintain remission of UC

Answer 16

Same as crohns

Question 17

What are the indications for surgery for UC

Answer 17

disease refractory to medical management, toxic megacolon, or bowel perforation. Surgery may also be undertaken to reduce the risk of colonic carcinoma, if dysplastic cells are detected on routine monitoring.

Question 18

What is the curative surgical management of UC

Answer 18

Total proctocolectomy is curative* (with the patient requiring an ileostomy), yet many patients for disease control will often initially undergo a sub-total colectomy with preservation of the rectum

Question 19

What are the complications of UC

Answer 19

Toxic megacolon

Colorectal carcinoma

Osteoporosis

Pouchitis - inflammation of the ileal pouch