UC

Question 1

What is UC?

Answer 1

Chronic inflammatory ulcerative disease affecting mucosa of rectum and colon

Question 2

Where does UC normally occur?

Answer 2

Starts in rectum and moves proximally

Rectum most common site

Question 3

What is the histology in UC?

Answer 3

Continuous inflammation
Confined to mucosa
Raw, red mucosa that bleeds easily
Crypt abscesses and ulceration
Pseudopolyps

Question 4

Who is UC seen in?

Answer 4

15-30yo= major peak
50-70yo= minor peak

Question 5

What are the features of UC?

Answer 5

Bloody diarrhoea
Urgency
Passage of mucus
Abdo pain
Lethargy, malaise
Arthritis, uveitis, clubbing

Question 6

What are the features of a severe attack of UC?

Answer 6

Stool frequency >6x/d with blood
Fever >37.5
Tachycardia >90
High CRP
Anaemia
Low albumin
Leucocytosis, thrombocytosis

Question 7

What investigations are done in UC?

Answer 7

Bloods- raised CRP and ESR, anaemia, pANCA +
Raised faecal calprotectin
Colonoscopy and biopsy- diagnostic

Question 8

What investigations are done in an acute attack of UC?

Answer 8

Daily bloods- FBC, U&Es, albumin
AXR
Erect CXR
CT

Question 9

How is a severe attack of UC managed?

Answer 9

Hospital admission and IV prednisolone

Infliximab if non responsive disease

Question 10

How is a mild to moderate attack of UC managed?

Answer 10

Topical aminosalicylate

Question 11

What are the indications for surgery in acute attack of UC?

Answer 11

Failure to respond to medical management
Toxic megacolon
Perforation
Massive haemorrhage

Question 12

What are the indications for surgery in chronic UC?

Answer 12

Failure of medical management
Continuous disabling symptoms
Carcinoma, dysplasia or high risk of carcinoma

Question 13

What surgery is done in acute UC?

Answer 13

Total colectomy, ileostomy and EITHER

• closure of rectal stump OR
• rectosigmoid mucus fistula

Question 14

What revision surgery is done after acute UC surgery?

Answer 14

Excision of rectuma nd permanent ileostomy OR

Ileal pouch

Question 15

What surgery is doe in chronic UC?

Answer 15

Total proctocolectomy and EITHER

• permanent ileostomy OR
• ileal pouch

Question 16

What are the indications for an ileal pouch?

Answer 16

Young person,
continent
UC

Question 17

What are the contraindications for an ileal pouch?

Answer 17

Crohn’s

anal incontinence

Question 18

What are the local complications of UC?

Answer 18

High risk colorectal cancer
Blood loss and anaemia
Protein loss
Toxic megacolon
Perforation

Question 19

What is done for the colorectal cancer risk in UC?

Answer 19

Remove any strictures as likely to become cancerous
Surveillance colonoscopy
-total colitis >10 years
-left sided colitis >15 years

Question 20

What is toxic megacolon?

Answer 20

Transverse or right colon with diameter >6cm with loss of haustration

Question 21

What is the management of toxic megacolon?

Answer 21

Medical management

Failure to make dramatic improvement in 48 hours –> surgery

Question 22

How is a perforation detected in UC?

Answer 22

AXR and erect CXR

Physical signs not reliable due to immunomodulation

Question 23

What are the systemic complications of UC?

Answer 23

Large joint disease
Uveitis
Spondylitis
Liver disease
Increased risk cholangiocarcinoma
Skin- erythema nodosum

Question 24

What are the options for maintaining remission in UC?

Answer 24

1. 5ASA
2. Azathiprine
3. Infliximab