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18 Cards in this Set
- Front
- Back
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Ulcerative colitis |
Inflammation of mucosal layer of colon esp at rectum and extends proximal in continuous manner |
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Clinical manifestations |
Abdominal pain, tenesmus, rectal bleeding, incontinence. Anemia of chronic disease, autoimmune hemolytic anemia and iron deficiency anemia - palpitations, weakness, tiredness, dysnea, fever weightloss |
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Disease severity |
Based on lab findings, diarrhoea and systemic symptoms 1. Mild 2. Moderate 3. Severe |
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Mild disease |
Stool <4 +/- blood, mild abdominal pain and cramps, constipation. Normal ESR no severe systemic signs |
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Moderate disease |
>4 stools/ day with blood. Mild anemia doesn't require transfusion. Minimal systemic toxicity- low grade fever. |
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Severe disease |
Frequent loose stools Bloody High ESR >30mm/HR Systemic toxicity - fever, weightloss, tachycardia, anemia- <10.5 |
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Extra intestinal symptoms |
MSK- arthritis, osteoporosis. Osteopenia, ankylosis spondylitis, osteonecrosis Eye- uveitis, episcleritis, iritis and conjunctivitis Skin- erythema nodosum and pyoderma gangreosum Hepatobiliary- primary sclerosing cholangitis, fatty liver, autoimmune liver disease Hemopoietic/ coagulation - venous and arterial thromboembolism Pulmonary - airway inflammation, parenchymal lung disease, serositis, thromboembolic disease |
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Laboratory |
High ESR deranged electrolytes High ALP in cholangitis Fecal calprotectin and lactoferrin CRP PCR for c difficile Stool for typhi, shigella Hiv and gonorrhea |
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Imaging |
Xray- fulminant UC- thumbprinting - edema and colonic dilation Barium enema- reticulated pattern in ulcerative areas. Severe disease - spiculated collar button ulcers, shortening of colon and loss of haustra and narrowing of luminal caliber, pseudopolyps and filiform polyps. Caution avoid barium enema in severe cases to avoid ileus and toxic megacolon |
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Ultrasound findings |
Hypoechoiec regions with active disease |
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Risk factors |
Antibiotics associated diarrhea c difficile Parasitic infection amoeba Nsaid use STI HIV/ CMV |
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Endoscopy |
Granularity Touch friability Edema and engorgement Bleeding Non neoplastic pseudopolyps |
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Biopsy |
Crypt lesions and abscess Crypt branching Crypt atrophy Epithelial cell abnormalities (mucin deletion and paneth cell metaplasia) Inflammatory features- increased lamina propria cellularity, basal plasmacytoid and basal lymphoid aggregates and lamina propria esinophils |
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Lesion pattern |
Continuous with sharp demarcation Circumferential |
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CMV COLITIS |
hematoxylin and eosin stain- enlarged cytomegalic cells Immunoperoxidase staining for CMV |
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Disease extent |
Proctitis- distal to rectum Proctosigmoiditis- rectum and sigmoid Left sided colitis- distal to splenic flexure Extensive colitis- proximal to splenic flexure |
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Complications |
1. Toxic megacolon and fulminant colitis Fulminant- >10 stools/day, continuous bleeding, distension and acute and severe symptoms. Toxic megacolon from extension of injury to muscle layer 2. Perforation - from absence of scarring from previous attacks- causes peritonitis 3. Severe bleeding- massive hemorrhage |
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Long term complications |
Strictures Colorectal cancer |
