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Pathology
Continuous inflammation from rectum and extending proximally, shallow ulceration, crypt abscesses
and goblet cell depletion
Aetiology
Unknown, increased incidence in those with relatives with IBD, decreased incidence in smokers
Signs
Abdominal tenderness
Symptoms
Bloody diarrhoea, malaise, urgency
Investigations
Bloods: FBC shows anaemia, reduced Ferritin, raised CRP / ESR, LFTs
Microbiology: Stool cultures
Imaging: Abdominal X-Ray may show toxic dilatation
Colonoscopy shows continuous erythematous mucosa, shallow ulcers
Treatment
Medical: Steroids to induce remission, 5-aminosalicylates (mesalazine) orally or
topically, azathioprine is used as a steroid sparing agent
Surgical: Colectomy in resistant disease and toxic dilatation
Prognosis
20-30% with pancolitis have a colectomy
Toxic dilatation (transverse colon > 5.5cm), perforation, malignancy, primary sclerosing cholangitis.
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Key References
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