IBD - UC

Question 1

Epidemiology:

Answer 1

Ulcerative Colitis > Crohn’s (1:1000 v 1:3000)

Highest prevalence in Caucasians, Jewish

Question 2

Risk Factors:

5

Answer 2

Age/Gender 
Tobacco use 
Appendectomy 
Genetics 
NSAIDS can activate

Question 3

Age/gender and IBD

Answer 3

15-40 yrs MC

Crohn’s dz is bimodal (incidence 50-70)

Female = Crohn’s,
Males = UC

Question 4

Tobacco use and UBD

Answer 4

Increased risk of crohn’s

Use of tobacco is protective against development of UC

Question 5

appendectomy and IBD risk

Answer 5

protective against development of UC

Question 6

histology of Crohn’s dx

Answer 6

skip lesions + transmural involvement

non-friable mucosa, cobblestoning

entire GI tract

thick, scarred

NON CASEATING granulomas

Question 7

histology of UC

Answer 7

superficial chronic inflammation, friable ulceration

contiguous involvement in colon

pseudopolyps and crypt abscess

Question 8

UC overview

Answer 8

chronic inflammatory condition

limited to mucosal layer of colon

more extensive disease = increased risk fo flare

Question 9

s/s UC

Answer 9

bloody diarrhea

lower abdomen cramping, fecal urgency and frequency

anemia, low albumin levels

Question 10

diagnosis UC

Answer 10

stool culture ** (to exclude infectious diarrhea)

CBC, ESR, ANCA/ASCA, Albumin

Endoscopy

Question 11

endoscopy evaluation of UC

Answer 11

location affected

appearance and biopsy for histology

Question 12

ASCA

Answer 12

antibodies that correlate Crohn’s disease

Question 13

ANCA

Answer 13

correlate with UC (cytoplasm of neutrophils)

Question 14

diagnostic test in UC

Answer 14

colonoscopy and biopsy

crypt abscess, branching, atrophy
pseudopolyps, inflammatory changes SUPERFICALLY

Question 15

UC classification based on stool frequency

Answer 15

<4 = mild 
>6 = severe

Question 16

UC acute attack tx

protitis/proctosigmoiditis

Answer 16

5-ASA suppository (Mesalamine)

IF needed PO 5ASA or corticosteroid enema

Question 17

UC acute attack tx

Mild/Mod UC

Answer 17

PO 5-ASA (Sulfasalazine)

no improvement in 5 wks = Budesonide (other corticosteroid)

If not working= immunomodulators

Question 18

when to consider total colectomy in mild mod UC flare

Answer 18

immunomodulators dont provide improvement in 72 hrs OR dilation of colon is seen on serial XR

Question 19

severe colitis tx

Answer 19

hospital admission, IVF, IV steroids, anti-TNF, surgical consult

Question 20

indications for surgical management in UC

Answer 20

severe hemorrhage, perforation, carcinoma

fulminant colitis/toxic megacolon that fails to improve in 72 hrs

relative: refractory to steroids

Question 21

surgical interventions in UC

Answer 21

colectomy + ileostomy

internal ileal pouch

total protocolectomy (can be curative)

Question 22

complications with UC surgical management

Answer 22

pouchitis

tx= probiotics and intermittent ABC

Question 23

maintenance therapy UC (steps)

Answer 23

1. oral 5-ASA agent (Mesalamine, Sulfasalazine)
2. immunomodulators (methotrexate)
3. Anti-TNF inhibitors

Question 24

indication for immunomodulators UC

Answer 24

> 2 relapses/yr

corticosteroid dependent disease

Question 25

supportive UC tx

Answer 25

fiber supplements

limit gas producing veggies (beans) and caffeine

avoid antidiarrheal agents

Question 26

fulminant toxic megacolon

Answer 26

rapidly progressing UC ove r1-2 weeks with signs of toxicity

Question 27

fulminant megacolon presentation

Answer 27

fever
toxic appearing
hemorrhage = transfusion
hypovolemia

Question 28

toxic megacolon management

Answer 28

IV abx (broad spectrum)

surgical consult for colectomy

Question 29

UC prognosis

Answer 29

75-85% will relapse
20% will req. colectomy

increased risk of colon CA

increased mortality if presentation >60