Ulcerative colitis Flashcards

1
Q

define UC?

A

chronic relapsing and remitting inflammatory disease affecting the large bowel

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2
Q

where does UC most commonly affect?

A

rectum

doesn’t spread beyond the ileocecal valve

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3
Q

how does UC pattern?

A

it is continuous

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4
Q

what are the risk factors for UC?

A

Possible genetic susceptibility

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5
Q

what might trigger flare ups of UC?

A

stress
NSAIDs
antibiotics
cessation of smoking

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6
Q

what is UC often associated with?

A
  • Primary sclerosing cholangitis
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7
Q

which groups is UC more common in?

A

o Ashkenazi jews
o Caucasians
• Uncommon before the age of 10 yrs
• Peak onset: 15-25 and 55-65

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8
Q

presenting symptoms of UC?

A
  • Bloody or mucous diarrhoea
  • Tenesmus and urgency
  • Crampy abdominal pain before passing stool
  • Weight loss
  • Fever
  • Extra-GI manifestations
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9
Q

what are the signs of UC on physical examination?

A
  • Signs of iron deficiency anaemia
  • Dehydration
  • Clubbing
  • Abdominal tenderness
  • Tachycardia
  • Blood, mucus and tenderness on PR examination
  • Extra-GI manifestations
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10
Q

what might the bloods show?

A
o	FBC: 
•	Low Hb 
•	High WCC 
o	High ESR or CRP 
o	Low albumin
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11
Q

what might a stool sample show?

A

o Infectious colitis is a differential diagnosis so a stool culture maybe useful
o Faecal calprotectin allows differentiation of IBS from IBD

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12
Q

what will an AXR rule out?

A

o Rule out toxic megacolon

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13
Q

what are the features of toxic megacolon?

A

transverse colon >6cm in diameter

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14
Q

what will a colonoscopy show?

A

o Determines severity
o Histological confirmation
o Detection of dysplasia

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15
Q

what feature might a barium enema show?

A

o Loss of haustral pattern – lead-pipe appearance

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16
Q

what is mild UC ?

A

< 4 stools/day only a small amount of blood

No systemic features

17
Q

what is moderate UC ?

A

4-6 stools/day
varying amounts of blood
no systemic upset

18
Q

what is severe UC?

A
>6 bloody stools per day
Blood in stools At least one of the following: 
Temp>37.8 
HR >90 bpm 
Anaemia >105g/L
ESR >30mm/hour
19
Q

how to manage an acute severe exacerbation?

A

o Admission to hospital
o IV rehydration
o IV corticosteroids
o No improvement after 72 hours – add ciclosporin or consider surgery

20
Q

how to treat toxic megacolon?

A

proctocolectomy

21
Q

when does the patient need immunosuppression?

A

o If a patient has a severe relapse or >2 relapses in a year they need immunosuppression

22
Q

how to manage moderate disease?

A

o Rectal 5-ASA derivatives and high dose oral 5-ASA derivative
o If remission is not achieved in 4 weeks, offer high dose 5-ASA derivatives and oral corticosteroid.
o Immunosuppression

23
Q

how to manage mild disease?

A

o rectal 5-ASA derivatives
o add oral 5-ASA derivative after 4 weeks
o add topical or oral corticosteroid
o if extending past left sided colon treat as moderate

24
Q

how to advice the patient?

A

o Patient education and support
o Treat complications
o Regular colonoscopic surveillance

25
Q

what are the surgical interventions?

A
  • Proctocolectomy with ileostomy

* Ileo-anal pouch formation

26
Q

GI complications of UC?

A
o	Haemorrhage  
o	Toxic megacolon 
o	Perforation 
o	Colonic carcinoma  
o	Gallstones  
o	Primary sclerosing cholangitis
27
Q

extra GI complications of UC?

A
o	Uveitis  
o	Renal calculi 
o	Arthropathy 
o	Sacroiliitis  
o	Ankylosing spondylitis  
o	Erythema nodosum 
o	Pyoderma gangrenosum  
o	Osteoporosis (from chronic steroid use)  
o	Amyloidosis
28
Q

prognosis of UC?

A
•	Normal life expectancy  
•	Poor prognostic factors: 
o	Low albumin (< 30 g/L) 
o	PR blood  
o	Raised CRP 
o	Dilated loops of bowel  
o	8+ bowel movements per day  
o	Fever