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A Talk on Ulcerative Colitis

Introduction. Ulcerative Colitis is one of two main IBDs.The other being Crohn's Disease.Crohn's Disease occurs mouth to anus.Whereas UC affects only the large bowel.Relapsing

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A Talk on Ulcerative Colitis

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    1. A Talk on Ulcerative Colitis By Gary Heron 3rd Year Medical Student

    2. Introduction Ulcerative Colitis is one of two main IBDs. The other being Crohn’s Disease. Crohn’s Disease occurs mouth to anus. Whereas UC affects only the large bowel. Relapsing & remitting inflammatory disorder of the colonic mucosa. Can be proctitis or pancolitis.

    3. Aetiology Broadly speaking unknown. Environmental factors operating in genetically predisposed. Insult to intestinal epithelial integrity ? bacteria & luminal Ags ? aberrant IR Th-2 dominant ? ?IL-5 Betis (Infect Immun 71 1774) – UC may involve E coli ? ?IL-8 ? ?WBCs

    4. Pathogenesis

    5. Macroscopic & Histological Affects only the colon. Begins in rectum, extends proximally. Continuous involvement. Red mucosa easily bleeds. Ulcers & pseudopolyps. No granulomata. Crypt abscesses and ?GCs. Th-2 mediated.

    6. Investigations Bloods; FBC, ?Platelet count, ?ESR and ?CRP. U&Es, LFTs, ?Serum Albumin? Blood cultures; infective agent? MC+S and CDT – exclude infectious diarrhoea. Radiology; AXR – toxic dilation (>6cm). Endoscopy; sigmoidoscopy – rectal biopsy. Colonoscopy. Barium enema – never during acute attack.

    7. Management MEDICAL Corticoids PO (prednisolone) Severe IV (hydrocortisone 100mg/6h). Proctosigmoiditis – enemas (mesalazine 250mg/8h PR). Blood transfusion if Hb<10g/dL. TPN – severe malnourishment. IM vitamins.

    8. 5-ASAs and Azathioprine Mesalazine, olsalazine and balsalazine. Anti-inflammatory – induces remission in mild UC. ?doses useful as maintenance to ?no. of relapses (80 – 20% @1 yr). Azathioprine – immunomodulatory ?IS. Pro-drug ? 6-mercaptopurine and 6-thioinosinic acid.

    9. Surgical Interventions Indications; perforation, massive haemorrhage, toxic dilation. Main indication is a failure to respond to medical intervention.

    10. Options Ileoanal anastomosis “pouch” patient remains continent.

    11. Panproctocolectomy with ileostomy Whole colon and rectum removed and the ileum is brought out to the abdominal wall as a stoma.

    12. Colectomy with ileorectal anastomosis Diseased rectum left in situ and diarrhoea may still occur.

    13. Course and prognosis UC presents with bloody diarrhoea. Clinical may be one of persistant diarrhoea, relapses & remissions or severe fulminant colitis. Progression ?variable. 10% proctitis patients ? extensive disease However with fulminant disease ? perforation and death.

    14. Cancer? Extensive UC of >10yrs duration ? ?risk of colorectal cancer (12% over 25yrs). Offered surveillance colonoscopy @ 1-2yr intervals. Colectomy recommended if ?dysplasia is discovered.

    15. Thanks…

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