FN: Ulcerative collitis management Flashcards
Investigations
Bloods
Stool
Imaging
Blods shows
- Reduced Hb, raised WCC
- LFT: reduced albumin
- CRP/ESR raised
- Blood cultures
Stool
MCS: exclude campy, shigella, salmonella
CDT: C.diff may complicate or mimic
Imaging
- AXR: megacolon (>6cm), wall thickening
- CXR: perforation
- CT
- Ba/gastrogaffin enema
Ileocolonoscopy + regional biopsy: Baron score
Severity score
Truelove and witts criteria Motions PR bleed Temp HR Hb ESR
Motions
Severe >6
Mild
Acuter Severe UC management
- REsus: admit, IV hydration, NBM
- hydrocortisone: IV 100mg QDS + PR
- Transfuse if required
- Thromboprohpylaxis: LMWH
Acute complcations
Perforation
Bleeding
Toxic megacolon (>6cm)
VTE
Improvement –> orl therapy
Switch to oral perd and 5-ASA
taper pred after full remission
Non improvement on oral therapy
- On day 3: stool freqeuncy >8 or CRP >45 - predicts 85% chance of needing a colectomy during the admission
- Discussion between pt. physcian and surgeon
- Medical: ciclosporin, infliximab or visilzumab (anti-t cell)
Surgical
ORal therapy
5-ASA
prednisolone
Topical therapy
Mainly left sided disease
Practitis: suppositiries
Additional therapy
Steroid sparing
Azathiorpine or mercaptopurine
Infliximab: steroid - dependent ps
1st line
5-ASAsPO - sulfasalazine or mesalazine: topical Rx may be used in proctitis
2nd line
Azathioprine or mercaptopurine
- relapsed on ASA or are steroid-dependent
- Give 6-mercaptoprurine if azathioprine intolerant
3rd line
Infliximab/adalimumab
Indication sofr surgery
Toxic megacolon
Perforation
MAssive haemorrhage
Failure to respond to medical Rx
Surgical complications
Abdominal SBO Anastomotic stricture Pelvic abcess Stoma: retraction, stenosis, prolapse, dermatitis Pouch: Pouchitis (50%): metronidazolw + cipro Reduced female fertility Faecal leakage
Surgical complications
Abdominal SBO Anastomotic stricture Pelvic abcess Stoma: retraction, stenosis, prolapse, dermatitis Pouch: Pouchitis (50%): metronidazolw + cipro Reduced female fertility Faecal leakage
Elective surgery indications
- Chronic symptoms despite medical therapy
2. Carcinoma or high-grade dysplasia
Procedures
Panproctocolectomy with end ileostomy or IPAA
Total colectomy with IRA
