Ulcerative colitis
Background
- Neutrophil and lymphoplasmacytic inflammation through intestinal wall (mucosa and submucosa) with crypt abscesses
- Onset typically in late teens or 50-60yo
- M = F
- Smoking protective
- Usually insidious : recurrent diarrhoea, bloody stools, tenesmus, crampy abdo pain, low pyrexia, wt loss
- Occasionally acute arthropathy, scleritis, erythema nodosum, and pyoderma gangrenosum
- Rarely fulminant bleeding or massive colonic distension ± perforation
DDx rectal bleeding
- Infectious colitis
- Ischaemic colitis
- NSAID enteropathy
- Diverticulitis
- C. difficile
Investigations
- FBC (anaemia, leukocytosis)
- LFT (low albumin if protein losing enteropathy)
- U&E (diarrhoea losses)
- Baseline ESR and CRP
- PFA (one of few indications) to exclude megacolon
- CT if unsure of other pathology
- Thick colonic wall, pericolic fat stranding
- Definite Dx = sigmoidoscopy and Bx
- CONTRA-indicated in megacolon
Management
- ABC re significant blood loss, perforation, sepsis etc
- Rehydration
- ± blood transfusion
- Exclude / beware megacolon (involve surgeons EARLY)
- Bowel rest
- Steroids for acute flare
- 5-aminosalicylic acid (ASA) to maintain remission
- LMWH if not active bleeding (high risk VTE)
- Immunomodulators (e.g. Infliximab) in refractory disease
- Consider colectomy in severe cases
Content by Dr Íomhar O' Sullivan. Last reviewed by Dr ÍOS 12/04/23.