Ulcerative Colitis

A quick overview of all you need to know about ulcerative colitis. An Ed Wallitt original!

 

Lecture by

Video Duration: 8 minutes

  • Ulcerative Colitis
    Created by Dr Ed Wallitt
    General
    Epidemiology

    Common condition.

    Middle age with slight female proponderance.

    Smoking is PROTECTIVE and 20% will require surgery and some time.

    Pathology

    Macroscopic

    • Continuous involvement of colon + rectum with no strictures

    Microscopic

    • Mucosal inflammation and crypt abscesses
    • Shallow ulceration
    • Marked pseudopolyps
    Top three causes

    Unknown. Note that smoking is protective.

    Clinical Features
    Symptoms

    General: malaise anorexia and weight loss

    Specific

    • Bloody diarrhoea
    • Abdominal pain
    • Tenesmus and faecal urgency
    Signs

    Thin patient. May have erythema nodosum or pyoderma gangrenosum. Clubbing. Stoma bad

    Distended and tender abdomen

    Investigations
    Cultures

    Blood cultures (if fever), stool cultures (infection)

    Bloods

    FBC, LFTs, CRP

    Imaging

    Abdominal radiograph - megacolon (>6cm),

    Chest radiograph - air under diaphragm (perforation)

    Gastrograffin enema - lead piping and loss of haustra

    Scopic/Biopsy

    Colonoscopy/Sigmoidoscopy

    Functional

    None

    Treatment
    Conservative

    Score with the Truelove and Witts Criteria

    If acute colitis - fluid resuscitation and maintenance

    Medical

    Acute severe colitis - hydrocortisone IV + thromboprophylaxis

    Inducting remission - 5-ASA, suppositories and enemas/foams for proximal disease

    Maintenance - 5-ASAs. Azathioprine for those who relapse.

    Surgical

    Associated surgical emergencies are:

    • Toxic megacolon
    • Perforation
    • Massive haemorrhage
    • Failure to respond to medical treatment

    20% will require surgery (resections)