Ulcerative Colitis Flashcards
what is the definition of UC?
Ulcerative colitis (UC) is a type of inflammatory bowel disease that characteristically involves the rectum and extends proximally to affect a variable length of the colon.
what is the epidemiology of UC?
More common in western and northern hemispheres, lower incidence in asia and far east
Most aged 20-40 yrs at diagnosis
what is the aetiology of UC?
Unclear
Seems to occur in genetically susceptible people in response to environmental triggers
what are the risk factors for UC?
Family history
HLA-B27
Infection
NSAIDs, not smoking?
what is the pathophysiology of UC?
Macroscopically, most cases of UC arise in the rectum, with some patients developing terminal ileitis
The bowel wall is thin or of normal thickness, but the presence of oedema, the accumulation of fat, and hypertrophy of the muscle layer may give the impression of a thickened bowel wall. The term ‘proctitis’ is used when the inflammation is limited to the rectum.
Microscopically, UC usually involves only the mucosa, with the formation of crypt abscesses and a coexisting depletion of goblet cell mucin.
what are the key presentations of UC?
Presence of risk factors
Rectal bleeding
Diarrhoea
Blood in stool
what are the signs of UC?
Presence of risk factors
Arthritis
Spondylitis
Malnutrition
what are the symptoms of UC?
Blood in stool
Diarrhoea
Abdominal tenderness
Fever, weight loss, constipation, rash
what are the first line and gold standard investigations for UC?
Stool studies for infectious pathogens Faecal calprotectin FBC Comprehensive metabolic panel ESR CRP Plain abdominal radiograph Flexible sigmoidoscopy Colonoscopy Biopsies
what are the differential diagnoses for UC?
Crohn’s, indeterminate colitis, radiation colitis, infectious colitis, diverticulitis
how is UC managed?
Acute severe:
Hospital admission, IV corticosteroids, supportive measures, ciclosporin or infliximab, surgery
moderate :
Oral corticosteroid, biological agent, immunomodulator, tofacitinib, colectomy
Mild:
Topical or oral aminosalicylate, topical corticosteroids, oral budesonide
how is UC monitored?
Treatments and their complications should be closely monitored.
Patients with long-standing UC are at increased risk for development of dysplasia. The risk of colorectal cancer increases with longer duration and extensive severe colitis, family history of colorectal cancer, young age at onset of disease, presence of backwash ileitis, and personal history of primary sclerosing cholangitis
what are the complications of UC?
Toxic megacolon, perforation, infection, massive lower gastrointestinal bleed, colorectal cancer
what is the prognosis of UC?
Overall mortality does not appear to be increased in patients with UC compared with the general population. However, one population-based study carried out in Manitoba found an increased risk of mortality among UC patients within the first year from diagnosis when compared with matched controls
