Ulcerative colitis

• Relapsing and remitting inflammatory disorder of the colonic mucosa
• Only affects the colon – can affect proximal to the ileocaecal valve via backwash ileitis
• Presents age 15-30 – more common in non-smokers

Pathology

• Hyperaemic, haemorrhagic granular mucosa +/- pseudopolyps
• Is not transmural

Symptoms

• Gradual onset of diarrhoea, blood and mucus
• Crampy abdo discomfort
• During attacks there may be symptoms of systemic disease – fever, malaise, anorexia, weight loss

Signs

• In acute UC there may be fever, tachycardia, tender distended abdo
• Extra-intestinal signs;
  • Clubbing
  • Aphthous mouth ulcers
  • Erythema nodosum
  • Pyoderma gangrenosum
  • Conjunctivitis
  • Episcleritis
  • Iritis
  • Large joint arthritis
  • Sacroilitis
  • AS
  • Fatty liver
  • PSC
  • Cholangiocarcinoma
  • Renal stones
  • Osteomalacia
  • Nutritional defects
  • Amyloidosis

Tests

• Blood – FBC, CRP, ESR, U&Es, LFTs, blood cultures
• Stool cultures
• AXR and erect CXR (perforation)
• Sigmoidoscopy
• Barium enema – don’t do in acute disease – show loss of haustra, granular mucosa, shortened colon
• Colonoscopy

Severity can be assessed using Truelove and Witts criteria based upon;

• Number of motions a day
• Rectal bleeding
• Temperature
• Pulse
• Hb
• ESR

Complications

• Perforation
• Bleeding
• Toxic dilation of colon
• Venous thrombosis
• Colonic cancer (15% over 20 years with pancolitis)

Management

• Inducing remission;
  • Mild and moderate UC – prednisolone and a 5-aminosalicylic acid (sulfasalazine) plus steroid PR foams or ememas
• Severe UC- passing more than 6 motions a day and systemically unwell;
  • Admit – nil by mouth and rehydration
  • IV hydrocortisone
  • Rectal steroids
  • May need blood transfusion

• Surgery – 20% will require surgery at some stage