Ulcerative Colitis

University:
Western Sydney University
Course:
MEDI 2003 | Clinical Sciences 2
Academic year:

2024
Views:

245

Pages:

6
Author:

Mariam A. A.

Ulcerative Colitis Definition Chronic and relapsing-remitting inflammatory disease Affects colon and rectum Epidemiology Most common type of inflammatory bowel disease Bimodal distribution 15- to 30-year-olds and to 70-year-olds The rectum is the most affected part Risk factors Family history Strongest HLA-B27 positive Recent GI infection NSAIDs Smoking cessation Ashkenazi Jewish descent Classifications Type Description Rectum only Proctitis Most common Has the best prognosis Proctosigmoiditis Rectum and sigmoid Left sided colitis Left colon and sigmoid Extensive colitis Rectum, sigmoid, descending and transverse colon Entire colon Pancolitis Most severe Clinical features History Physical Exam Diarrhoea +/- blood +/- mucus Most common Urgency Tenesmus Lower abdominal pain Lower abdominal pain Abdominal discomfort Lower abdominal tenderness Bloating Abdominal distension Fatigue DRE Weight loss Screen for presence of blood Malaise Extra-intestinal findings Extra-intestinal manifestations Ophthalmic: iritis, uveitis, episcleritis Dermatological: erythema nodosum, pyoderma ganregnosum MSK: arthritis -> both small and large joints Nephrolithiasis Anaemia and thromboembolism Investigations Bloods FBC: anaemia and leucocytosis U&E Inflammatory markers -> elevated CRP LFT: low albumin -> severe disease pANCA Stool tests raised faecal calprotectin microscopy and culture to exclude infections -> important Imaging Endoscopy Gold standard Flexible sigmoidoscopy usually enough Findings: Continuous and uniformly enlarged inflamed mucosa Erythema Friable mucosa Ulcerations Inflammatory polyps (pseudopolyps) Biopsy Crypt abscesses decreased concentration of goblet cells usually, non-granulomatous Management Medical Management Therapy Description E.g. Mesalazine 5-ASA First line for induction and maintenance of remission of mild to moderate ulcerative colitis E.g. prednisolone Corticosteroids For induction of remission Not useful for maintenance E.g. azathioprine Used as a steroid sparing therapy -> reduces steroid related side effects Thiopurines Prior patients should have thiopurine methyltransferase activity checked Absent or reduced activity increases risk of myelosuppression When refractory to other treatment Anti-TNF-alpha Biologics Anti-L-12/23 Anti-a4b7 Surgical Management Indications: Cannot be adequately controlled by optimal medical therapy Occurrence of severe complications E.g. toxic megacolon or bowel perforation Options Type Description Resection of a part of the colon Subtotal Colectomy Most likely would need a temporary de-functioning loop ileostomy To protect site of anastomosis c Resection of entire colon and rectum Complete proctocolectomy Need permanent ileostomy Resection of entire colon and rectum Temporary loop ileostomy Restorative proctocolectomy Reversed later with further surgery Joining of ileal pouch to anal canal Complications Anaemia -> IDA Most common Severe bleeding Bowel perforation Toxic megacolon Malnutrition Venous thromboembolism Osteoporosis Colorectal cancer Surveillance offered to patients with long standing UC