GI Packet #6

Ulcerative Colitis (UC)

Disease of the colon (large bowel) that causes inflammation and ulceration

UC also involves what body part (1) and can precede in which direction (2)?

1. Rectum

2. Proximally (closer to the midway; up the descending colon, into transverse, then the ascending)

TRUE OR FALSE: UC moves into the small intestine.

False

What is the first peak age for UC?

20-30 years old

What is the second peak age for UC?

50-70 years old

What occurs at the peak age?

Onset when Pt develops Sx

What population(s) is UC the most common in? (2)

1. Caucasians

2. Specific Jewish populations

Causes of UC (5)

1. Unknown

2. Overactive immune system

3. Genetic component

4. Environment

5. Microbial components

How can the environment be a cause of UC? (3)

1. High-fat diet

2. Chronic use of NSAIDs

3. Chronic use of antibiotics

Sx of UC (5)

1. Diarrhea with blood or pus

2. Abdominal pain

3. Rectal urgency

4. Weight loss via chronic diarrhea

5. Fever, sometimes

Dx of UC (4)

1. Detailed medical and family Hx

2. Physical exam

3. Endoscopic exam of the large intestine with possible biopsy

4. Lab work

What can you ask the Pt when taking a history?

Has anyone in your family experienced these same Sx?

What kind of tests can be done during the physical exam? (2)

1. Abdominal exam

2. Rectal exam

What kind of endoscopic tests can be done to evaluate UC? (2)

1. Colonoscopy

2. Sigmoidoscopy

What kind of lab work can be done, and why is it done?

To evaluate anemia, inflammation, or infection; Used to rule out other possible causes

TRUE OR FALSE: Tx for UC can be used solely or collectively.

True

Tx for mild Sx of UC

OTC antidiarrheals

What antidiarrheal is most commonly used?

Imodium

What are the 4 Rx medications that can be used for UC?

1. Steroids

2. Aminosalicylates

3. Immunomodulators

4. TNF Inhibitors/Biologics

What happens if steroids are used long term?

Sequela of osteoporosis

What is an example of a steroid?

Prednisone

What do aminosalicylates do?

Can be used in addition to steroids to help prevent flares

What is an example of an aminosalicylate?

Azulfidine

What do immunomodulators do?

Interfere with DNA synthesis in the cells and immune system

What are 2 examples of immunomodulators?

1. Methotrexate (used to Tx RA)

2. Imuran

What do TNF inhibitors/biologics do?

Target TNF and neutralize the protein by decreasing inflammation (an effect of UC)

TNF

Proteins made by the immune system

What is the possible surgical Tx of severe Sx of UC?

Partial or total colectomy

When would a Pt need a colostomy bag?

After having a total colectomy

Complications of UC (2)

1. Colon cancer when Pt has UC>10 years

2. Toxic megacolon

What is toxic megacolon?

Inflammation transmurally (all of colon)

What can toxic megacolon cause?

Severe dilation and paralysis of colon leading to perforation or sepsis

What is the death rate of toxic megacolon?

20%

Crohn's disease is AKA

Regional enteritis

Crohn's disease

Chronic inflammatory condition that occurs in the distal ileum and also involves the colon, as well as the esophagus and stomach

What kind of conditions does Crohn's fluctuate between?

Active and inactive (remission)

First peak age for Crohn's

15-30 years old

Second peak age for Crohn's

50-70 years old

What population(s) does Crohn's target? (2)

1. Caucasian

2. Specific Jewish populations

Causes of Crohn's (5; all same as UC)

1. Unknown

2. Overactive immune system

3. Genetic component

4. Environment.

5. Microbial components

Sx of Crohn's (5, all same as UC)

1. Diarrhea with blood or pus

2. Abdominal pain

3. Rectal urgency

4. Weight loss via chronic diarrhea

5. Fever, sometimes

What differs UC and Crohn's? (2)

1. Location

2. Pattern of inflammation

Differences in location of UC and Crohn's

1. UC: Confined to colon and may effect distal ileum

2. Crohn's: Usually distal ileum, but an be involved into colon, stomach, and esophagus

Differences in pattern of inflammation of UC and Crohn's

1. UC: Involves superficial layers of the inner bowel and tends to be uniform and diffuse

2. Crohn's Inflammation concentrated in some areas more than others, skips sections (regional), and can involve deep and superficial layers

Complications of Crohn's (3)

1. Increased risk of colon cancer having Crohn's >10 years (not as high a risk as UC)

2. Full thickness inflammation can cause obstruction, abscess formation, or fistula formation

3. Stricture

Fistula

Connection where there should not be one; Ex. Rectovaginal fistula

Stricture

Narrowing of a passage or body

Dx of Crohn's (4, same as UC)

1. Medical and family Hx

2. Physical exam with abdominal and rectal

3. Endoscopic exam with possible biopsy

4. Lab work to rule out other diseases

What do labs hold a purpose for in Dx of Crohn's?

Eliminates other diseases (via CBC, comprehensive panel)

What is the name of the blood test used to distinguish Crohn's from UC?

ASCA

When is this blood test done?

After utilization of biopsy and scans

Tx of Crohn's (6, same as UC)

1. OTC antidiarrheals (mild Sx)

2. Steroids

3. Aminosalicylates

4. Immunomodulators

5. TNF inhibitors/Biologics

6. Partial or total colectomu