Ulcerative Colitis
Definition
Epidemiology
Aetiology
Idiopathic
Risk Factors
Clinical Features
Symptoms
Signs
Investigations
Bedside: Faecal culture (ddx gastroenteritis), faecal calprotectin (+ for infl process), C. diff toxin (gastroenteritis)
Blood: FBC (infl, anaemia), UEC (renal function), Fe studies (anaemia), CRP/ ESR (infl), p-ANCA (+ CD/ -- UC), ASCA (- CD/ + UC)
Imaging: AXR (colonic distention, mucosal thickening, thumbprinting), Erect CXR (perforation), Barium enema*, Colonoscopy (crypt abscess, mucosal ulcers, inflammed friable mucosa)
NOTE: barium enema CONTRAINDICATED during acute attack and not a diagnostic test
Management
Medical:
Surgical
Ongoing mx
Complications
Source
OHCM 9th Ed 2014
- Relapsing and remitting inflammatory disorder of colonic mucosa
- Not transmural, ulcers extend furthest to lamina propria
Epidemiology
- 50% protitis,, 30% left sided colitis, 20% pancolitis
- Prevalence: 1:1000
- M=F
- Peak presentation @ 15-30y
Aetiology
Idiopathic
Risk Factors
- Family history (genetic)
- Smoking is NOT a risk factor (sx relapse on smoking cessation)
Clinical Features
Symptoms
- Gradual diarrhoea +/- blood/ mucous
- Abdominal cramp/ distension
- ++ bowel movements
- During attacks: fever, malaise, bleeding, anorexia, weight loss
Signs
- Could be none
- Attack: fever, tachycardia, distention, tenderness
- EIM: Iritis, episcleritis, large joint pain, ankylosing spondylitis, erythema nodosum, pyoderma gangrenosum, primary sclerosing cholangitis, cholangiocarcinoma
Investigations
Bedside: Faecal culture (ddx gastroenteritis), faecal calprotectin (+ for infl process), C. diff toxin (gastroenteritis)
Blood: FBC (infl, anaemia), UEC (renal function), Fe studies (anaemia), CRP/ ESR (infl), p-ANCA (+ CD/ -- UC), ASCA (- CD/ + UC)
Imaging: AXR (colonic distention, mucosal thickening, thumbprinting), Erect CXR (perforation), Barium enema*, Colonoscopy (crypt abscess, mucosal ulcers, inflammed friable mucosa)
NOTE: barium enema CONTRAINDICATED during acute attack and not a diagnostic test
Management
Medical:
- 5-ASA
- Prednisolone/ hydrocortisone suppository
- Cyclosporin
- Infliximab
Surgical
- Resection + ileoanal pouch + ileorectal anastomosis
Ongoing mx
- Protoscopy to monitor for malignancy
Complications
- Toxic megacolon
- Perforation
- PSC/ cholangiocarcinoma
- Venous thrombosis
Source
OHCM 9th Ed 2014