UC Flashcards
What is it?
What happens to the colonic mucosa?
Where does it never go past?
What is it never?
What happens if it is severe? - 2
Relapsing and remitting IBD -
A continuous area of inflammation in rectum +/- colon
Colonic mucosa - inflamed and friable
Ileocaecal valve
Transmural
Inflammation and ulceration
What 2 age ranges is it more common in?
15-25 yrs
55-65 yrs
BIMODAL distribution
Presentation - Intestinal:
Describe the diarrhoea?
1 other symptom similar to period pains?
2 rectal symptoms are urgency and tenesmus****. Define them?
How does it tend to present compared to Crohn’s?
D - bloody in 75% of cases - may contain mucus *****
Cramps
Urgency occurs when the arrival of faeces in the rectum causes strong contractions and precipitate anal relaxation. In that situation, continence can only be maintained by the conscious contraction of the external anal sphincter.
A continual or recurrent inclination to evacuate the bowels, caused by a disorder of the rectum or other illness.
Gradually
UC - mucus in stool and tenesmus is the main difference
Presentation - UC Attacks:
Symptoms - 3
What may trigger it?
Tender distended abdo
Fever
Anorexia and weight loss
Infection
Presentation - Non-intestinal:
Eyes - 3
Mucosa of mouth - 1
Nails - 1
You also get erythema nodosum and pyoderma gangrenosum. Define both of them? - SAME IN CROHNS
Uveitis
Episcleritis
Conjunctivitis
Aphthous ulcers
Clubbing
A type of panniculitis, an inflammatory disorder affecting subcutaneous fat. It presents as tender red nodules on the anterior shins. Less commonly, they affect the thighs and forearms
A rare, inflammatory skin disease where painful pustules or nodules become ulcers that progressively grow.
Presentation - Hepatobiliary:
You also get primary sclerosing cholangitis. Define it? - UC ONLY
3 other hepatobiliary diseases that may present in conjunction with UC? - SAME IN CROHNS
A long-term progressive disease of the liver and gallbladder characterized by inflammation and scarring of the bile ducts which normally allow bile to drain from the gallbladder.
Chronic hepatitis
NAFLD
Cirrhosis
Risk factors:
One normal risk factor for other diseases but not for UC
One main one for UC
What gene increases the risk?
Not smoking - smoking makes it better for some reason
FH
HLA-B27
Investigations - Bloods - Why do you do the following:
- FBC - 2
- 2 other things you look for in the blood that could indicate inflammation
- CRP/ESR
- U&E, Mg and Ca
- LFT
- Antibodies for UC only
FBC - Haemoglobin and haematinics (iron, folate and B12) - patients usually have anaemia
Raised platelets
Low albumin
CRP/ESR - raised in inflammation
Nutritional deficiencies
Hepatobiliary disease
pANCA - antibodies (70% accurate in UC)
Investigations - stool:
What can be done to the stool to rule out infection?
Marker for inflammation and why it is used?
One important bacteria that may cause inflammation or colon and diarrhoea?
Culture to rule out infection
Faecal calprotectin
C. diff toxin
Investigations - endoscopy:
What type of endoscopy is used if acute and if chronic?
What would you see on endoscopy?
Limited flexible sigmoidoscopy with biopsy
Full colonoscopy
Crypt architecture changes including cryptitis and crypt abscesses
Investigations - AXR:
What may it show?
Perforation
Gross dilatation in a flare-up
Toxic megacolon (>6cm in transverse colon)
Management: GOAL IS TO MAINTAIN REMISSION
How do you assess the severity of UC?
Truelove and Witt’s Criteria
Management - Mild-moderate:
What is the first line Rx if distal disease (descending colon, rectosigmoid)?
What if it is more extensive (so proximal or refractory)?
What is second line?
5-ASA - mesalazine PR (enema)
5-ASA - mesalazine but PO
Add prednisolone PO + PR or Prednisolone PR
(PR - topical steroid foams or retention enemas)
Management - Severe
When is it classed as severe?
What should be done first?
What medication should be administered straight after and by what route?
What 2 medications can be given to induce remission for refractory disease (keeps coming back/unmanageable)?
What permanent solution is there if refractory (keeps coming back/unmanageable)? - 3
> 6 stools per day (usually bloody) + SYSTEMICALLY UNWELL (fever, tachycardia)
Admit and fluid resus
Corticosteroids IV
Ciclosporin - immunosuppressor
Biologics - Infliximab
Subtotal colectomy - avoided by above - done if they don’t improve
Management - Remission
What should be given if UC is rectosigmoid?
What should be given after a severe attack or if needed steroids twice in a yr?
Mesalazine PO + PR or PR - same as first-line for mild-moderate attack
Immunusuppressors:
- Azathioprine
- Mercaptopurine
