Ulcerative Colitis

Question 1

Where does it affect?

Answer 1

Only Large Intestine and Rectum (always rectum)

Question 2

Aetiology?

Answer 2

some genetic susceptibility- pANCA positive in 75% of cases

Question 3

pathology?

Answer 3

relapsing and remitting colonic inflammation of the mucosa and submucosa

Question 4

main presentation?

Answer 4

• diarrhoea with blood and mucous
• abdominal pain
• weight loss

Question 5

symptoms & signs? (mnemonic)

Answer 5

Ulcers in mucosa & submucosa

Large Intestine affected (rectum always)

Clubbing

Erythema nodosum

Remnant of old polyps - pseudopolyps

Stool bloody

Inflamed, red granular mucosa

Neutrophil invasion

Abscess in crypts

Biochemical markers elevated ie ESR- fever and tachycardia in acute exacerbation

Diarrhoea

Question 6

Investigations?

Answer 6

• Bloods
• FBC
• ESR
• CRP
• Stool sample
• send for MC&S
• test for C.Diff toxin
• foecal calprotectin
• Imaging
• X-Ray w/ Barium enema
• Sigmoidscopy w/ biopsy

Question 7

what do you see on AxR?

Answer 7

mucosal thickening, dilatation and perforation

Question 8

what do you see on sigmoidoscopy?

Answer 8

inflamed mucosa, ulcers

Question 9

what do you see on barium enema?

Answer 9

loss of haustra

Question 10

Management? (mnemonic)

Answer 10

SAAS

Steroids- oral prednisolone

5-Aminosalicyclic Acid

Azathioprine - immunosuppressant

S- proctocolectomy + terminal ilesotomy