Colitis ulcerosa

Question 1

Hallmark

Answer 1

Bloody, slimy diarrhoea

Question 2

Pathophysiology

Answer 2

granulocytic inflammation of mucosa

Question 3

Most frequent localisation

Answer 3

Rectum

Question 4

Extra-intestinal manifestations (5)

Answer 4

Arthritis
Uveitis
Pyoderma gangrenosum
Primary sclerosing cholangitis
Erythema nodosum

1/3 will have extra intestinal manifestations

Question 5

Forms

Answer 5

Montreal endoscopic classification

Proctitis 21%
Proctosigmoiditis (not in Montreal)
Left colitis, up to splenic angle 36%
Pancolitis 41,5%

Rectum almost always at risk

Question 6

Classification

Answer 6

Truelove et Witts

Number of stool passage / 24h
Temperature
Pulse
Hemoglobin
SR

Question 7

Risk of Cancer

Answer 7

after 10 years of disease : 0.1-0.8%
1% for each additional 10 years

Sclorising cholangitis is a risk factor
Family hx of colon cancer adds up

Question 8

Colonoscopy recommended

Answer 8

Low risk at 8 years + every 5 years
Middle risk at 8 years + every 2-3 years
High risk at 8 years + yearly

If sclerosing cholangitis : at time of dx + every year

Question 9

Main therapy (general)

Answer 9

5 ASA (asacol, salofalk)

Question 10

Main therapy rectal

Answer 10

5 ASA supp

Question 11

Main therapy left sided

Answer 11

5 ASA foam enema

Question 12

Recurrence under 5 ASA

Answer 12

Cyclosporine

Question 13

Indication for operation

Answer 13

Toxic megacolon
Therapy refractory
Dysplasia
Carcinoma
Bleeding
Perforation

Emergency :
- subtotal Colectomy +/- ileostomy +/- PA
J-pouch (IPAA) reconstruction electively

Question 14

Anastomosis insufficiency rate J-Pouch

Answer 14

20-40%

Question 15

Pouchitis %

Answer 15

50% over 10 years

Question 16

Therapy of pouchitis

Answer 16

Metronidazole

5 ASA vs Steroid Enema

Question 17

Stool frequency and continency with IPAA

Answer 17

6 stools per day

only 70% are continent

Question 18

Toxic megacolon

Answer 18

> 5.5cm

Question 19

Primary Imaging

Answer 19

X-ray to exclude dilatation and toxic megacolon

CT Scan

Question 20

Main therapy if pancolitis

Answer 20

5 asa foam enema + 5 asa oral

Question 21

If therapy 1 fails

Answer 21

ad budenosid
or
Azathioprine

if fails, consider anti TNF alpha or Vedolizumab