FN: Ulcerative collitis management

Question 1

Investigations

Answer 1

Bloods
Stool
Imaging

Question 2

Blods shows

Answer 2

1. Reduced Hb, raised WCC
2. LFT: reduced albumin
3. CRP/ESR raised
4. Blood cultures

Question 3

Stool

Answer 3

MCS: exclude campy, shigella, salmonella
CDT: C.diff may complicate or mimic

Question 4

Imaging

Answer 4

1. AXR: megacolon (>6cm), wall thickening
2. CXR: perforation
3. CT
4. Ba/gastrogaffin enema
   Ileocolonoscopy + regional biopsy: Baron score

Question 5

Severity score

Answer 5

Truelove and witts criteria
Motions
PR bleed
Temp
HR
Hb
ESR

Question 6

Motions

Answer 6

Severe >6

Mild

Question 7

Acuter Severe UC management

Answer 7

1. REsus: admit, IV hydration, NBM
2. hydrocortisone: IV 100mg QDS + PR
3. Transfuse if required
4. Thromboprohpylaxis: LMWH

Question 8

Acute complcations

Answer 8

Perforation
Bleeding
Toxic megacolon (>6cm)
VTE

Question 9

Improvement –> orl therapy

Answer 9

Switch to oral perd and 5-ASA

taper pred after full remission

Question 10

Non improvement on oral therapy

Answer 10

1. On day 3: stool freqeuncy >8 or CRP >45 - predicts 85% chance of needing a colectomy during the admission
2. Discussion between pt. physcian and surgeon
3. Medical: ciclosporin, infliximab or visilzumab (anti-t cell)
   Surgical

Question 11

ORal therapy

Answer 11

5-ASA

prednisolone

Question 12

Topical therapy

Answer 12

Mainly left sided disease

Practitis: suppositiries

Question 13

Additional therapy

Answer 13

Steroid sparing
Azathiorpine or mercaptopurine
Infliximab: steroid - dependent ps

Question 14

1st line

Answer 14

5-ASAsPO - sulfasalazine or mesalazine: topical Rx may be used in proctitis

Question 15

2nd line

Answer 15

Azathioprine or mercaptopurine

1. relapsed on ASA or are steroid-dependent
2. Give 6-mercaptoprurine if azathioprine intolerant

Question 16

3rd line

Answer 16

Infliximab/adalimumab

Question 17

Indication sofr surgery

Answer 17

Toxic megacolon
Perforation
MAssive haemorrhage
Failure to respond to medical Rx

Question 18

Surgical complications

Answer 18

Abdominal
SBO
Anastomotic stricture
Pelvic abcess
Stoma: retraction, stenosis, prolapse, dermatitis
Pouch:
Pouchitis (50%): metronidazolw + cipro
Reduced female fertility
Faecal leakage

Question 19

Surgical complications

Answer 19

Abdominal
SBO
Anastomotic stricture
Pelvic abcess
Stoma: retraction, stenosis, prolapse, dermatitis
Pouch:
Pouchitis (50%): metronidazolw + cipro
Reduced female fertility
Faecal leakage

Question 20

Elective surgery indications

Answer 20

1. Chronic symptoms despite medical therapy

2. Carcinoma or high-grade dysplasia

Question 21

Procedures

Answer 21

Panproctocolectomy with end ileostomy or IPAA

Total colectomy with IRA