Exam III: Ulcerative Colitis

Question 1

Name the number of stools typically seen in remission, mild, moderate, and fulminant UC.

Answer 1

Remission = Formed Stools
Mild = <4
Moderate-Severe = >6
Fulminant = >10

Question 2

How often is blood in the stool for each of the following cases:

Remission, mild dx, mod/sev, fulminant

Answer 2

Remission = none
Mild = Intermittent
Mod/Severe = Frequent
Fulminant = Continous

Question 3

When is ESR affected in UC?

Answer 3

Moderate/Severe = 75% normal
Fulminant = Transfusion required

Question 4

When is CRP >30 in UC?

Answer 4

Mod-Severe and Fulminant Disease

Question 5

What are the endoscopy May subscores for remission, mild dx, mod-severe dx, fulminant dx

Answer 5

Remission = 0-1
Mild = 0-1
Mod-Severe = 2-3
Fulminant = 3

Question 6

What are the UCEIS scores for remission, mild, mod-severe, and fulminant disease?

Answer 6

Remission = 0-1
Mild = 2-4
Moderate =5-8
Fulminant = 7-8

Question 7

What is the first line, second line, and third line treatments for mild distal UC?

Answer 7

1st Line = Topical 5-ASA (at least 1 gram per day)
*Mesalamine Suppository 1000 mg/day
*Mesalamine enemas 1000 mg/day

2nd Line = Oral 5-ASA –> at least 2-2.4 grams/day
*Mesalamine Oral

3rd Line = Uceris (budesonide)

Question 8

How do we treat mild extensive disease? what are the first line and second line options?

Answer 8

1st Line = Oral 5-ASA (2-2.4 g/day)
2nd Line = Uceris (9 mg/day)

Question 9

What is the UC Maintenance therapy for Distal disease?

Answer 9

Same as Active Treatment

Question 10

What is the maintenance therapy for mild extensive disease?

Answer 10

Oral-5 ASA (at least 2 g/day)

consider combination with rectal preps.

Question 11

How do we treat moderate = Severe Colitis?

Answer 11

1. Uceris (budesonide) —> For 5 weeks
2. Prednisone PO (40-60 mg/day)
3. Biologic Therapy (Adalimumab, Golimumab, Infliximab, Vedolizumab)
4. Tofacitinib

Question 12

Which biologics are used to treat UC?

Answer 12

1. Adaldimumab
2. Golimumab
3. Infliximab
4. Vedolizumab

Question 13

How do we treat Acute Severe Colitis requiring hospitalization? What are our 1st,2nd,3rd line options?

Answer 13

1. Test for C.diff
2. IV Steroids for 3 days-5 days (hydrocortisone 300-400 mg or methylprednisolone 60 mg/day)
3. Steroid Failure = infliximab or Cyclosporine
4. 2nd Line failure = Colectomy

Question 14

What agents do we give for maintenance therapy for patients who were previously moderate-severe based on the drug which caused remission?

Answer 14

Steroid Induced = Thiopurine

Biologic Induced = Continue Biologic

Cyclosporine Induced = Thiopurine or Vedolizumab

Question 15

Why don’t we use mesalamine for moderate-severe UC treatment?

Answer 15

Little evidence to support benefit for these patients. However, it is a staple of therapy for low severity.