Ulcerative Colitis

Question 1

What is ulcerative colitis?

Answer 1

A recurrent inflammatory and ulcerating condition involving the mucosa of the colon

Question 2

What is happening to the incidence of ulcerative colitis over the last 20 years?

Answer 2

Increasing incidence

Question 3

Is ulcerative colitis more or less common that Crohn’s disease in children?

Answer 3

Less common

Question 4

What is a theory as to the aetiology of ulcerative colitis?

Answer 4

Colonic bacteria causing inflammation in the GI tract

Question 5

What is the presentation of ulcerative colitis?

Answer 5

Bloody diarrhoea
Colicky abdo pain
Urgency/tenesmus
Weight loss/growth failure (although less common than in Crohn's)
Malaise, fever etc.
Extra-intestinal manifestations
Abdo tenderness

Question 6

What are the extra-intestinal manifestations of ulcerative colitis?

Answer 6

Erythema nodosum

Arthritis

Question 7

What are the investigations for ulcerative colitis?

Answer 7

Bloods - FBC, electrolytes, CRP, ESR
Faecal calprotectin
Stool samples
Endoscopy

Question 8

What is the role of faecal calprotectin in the investigation of ulcerative colitis?

Answer 8

Detects colonic inflammation and helps to confirm need for referral

Question 9

What is the role of a stool sample in the investigation of ulcerative colitis?

Answer 9

To exclude infective causes

Question 10

What findings on endoscopy would suggest a diagnosis of ulcerative colitis?

Answer 10

Confluent colitis of variable length
Mucosal inflammation
Crypt damage
Ulceration

Question 11

What % of children have pancolitis?

Answer 11

90%

Question 12

How is Crohn’s excluded in ulcerative colitis?

Answer 12

Small bowel imaging

Question 13

What are the management options for ulcerative colitis?

Answer 13

Mesalazine
Steroids
Immunosuppressants
Biologic agents
Surgery

Question 14

What is 1st line for inducing and maintaining remission of ulcerative colitis and how is it taken?

Answer 14

Mesalazine

Taken topically or orally

Question 15

What is an example of a steroid used in ulcerative colitis and when is it used?

Answer 15

Prednisolone

To induce remission if no response to mesalazine within 4 weeks

Question 16

What is an example of an immunomodulatory therapy and when is it used in ulcerative colitis?

Answer 16

Azathioprine
To induce remission after acute exacerbations
To maintain remission if not achieved

Question 17

What is an example of a biologic agent and when is it used in ulcerative colitis?

Answer 17

Infliximab

In patients with resistant disease

Question 18

What surgery is used to manage ulcerative colitis and what is its role?

Answer 18

Colectomy w/ ileostomy/ileorectal pouch

Curative (because UC is confined to the colon)

Question 19

What % of ulcerative colitis patients will end up having surgery?

Answer 19

30%

Question 20

What are the complications of ulcerative colitis?

Answer 20

Colorectal cancer
Toxic megacolon (toxic meganostril)

Question 21

What is the risk of colorectal cancer with ulcerative colitis?

Answer 21

1 in 200 risk for each year of disease between 10-20 years from diagnosis

Question 22

What is the prognosis of ulcerative colitis?

Answer 22

Variable due to the unpredictable relapses and remission

Lifelong condition