Ulcerative Colitis

• What is ulcerative colitis?


  Chronic IBD

  Affects rectum first, then can extend to part of the colon or entire colon (pancolitis)

  Does not spread beyond ileocaecal valve
• What are the RFs of ulcerative colitis?


  FHx of IBD

  Infection

  Non-smoker
• What are the signs & symptoms of ulcerative colitis?


  Diarrhoea (often contains blood/mucous)

  Tenesmus or urgency

  Generalised crampy abdo pain in L iliac fossa

  Weight loss

  Fever

  Malaise

  Anorexia

  Pallor

  Anaemia

  Clubbing

  Abdo distension/tenderness

  Extra-intestinal signs
• What are the DDx of ulcerative colitis?


  Crohn's disease

  Infectious colitis

  Ischaemic colitis
• What are the Inx of ulcerative colitis?


  Obs

  Full Hx & examination

  Stool culture & sensitivity

  Faecal calprotectin

  Bloods (FBC, CRP, LFTs)

  Abdo XR

  Colonoscopy + biopsy

  Barium enema
• What will a colonoscopy show in UC?


  Continuous inflammation

  Starts at rectum does not go beyond submucosa with erythematous mucosa, loss of haustral markings & pseudopolyps
• What will a biopsy show in UC?


  Loss of goblet cells

  Crypt abscess

  Inflammatory cells (predominantly lymphocytes)
• What will a barium enema in UC?


  Lead pipe inflammation

  Thumb-printing (marker of bowel wall inflammation)

  Pseudopolyps
• What are the possible complications?

  Toxic megacolon

  Haemorrhage

  Colorectal cancer

  Primary sclerosing cholangitis

  Inflammatory pseudopolyps

  Increased risk of VTE
• What is the management of UC?


  Aminosalicylate (topical/oral)

  Prednisolone

  Surgery (panproctocolectomy with permanent end ileostomy, colectomy)

  Acute severe disease

  • IV corticosteroids
  • IV ciclosporin
• Pathophys - UC


  Colonic mucosa becomes acutely inflamed -> neutrophils accumulate in lamina propria & in tubular colonic glands -> crypt abscesses

  Sloughing of overlying mucosa -> small superficial ulcers

  If inflammation persists, can lead to extensive areas of ulceration -> can lead to pseudopolyps & increased risk of colon cancer