IBD - UC Flashcards
Epidemiology:
Ulcerative Colitis > Crohn’s (1:1000 v 1:3000)
Highest prevalence in Caucasians, Jewish
Risk Factors:
5
Age/Gender Tobacco use Appendectomy Genetics NSAIDS can activate
Age/gender and IBD
15-40 yrs MC
Crohn’s dz is bimodal (incidence 50-70)
Female = Crohn’s, Males = UC
Tobacco use and UBD
Increased risk of crohn’s
Use of tobacco is protective against development of UC
appendectomy and IBD risk
protective against development of UC
histology of Crohn’s dx
skip lesions + transmural involvement
non-friable mucosa, cobblestoning
entire GI tract
thick, scarred
NON CASEATING granulomas
histology of UC
superficial chronic inflammation, friable ulceration
contiguous involvement in colon
pseudopolyps and crypt abscess
UC overview
chronic inflammatory condition
limited to mucosal layer of colon
more extensive disease = increased risk fo flare
s/s UC
bloody diarrhea
lower abdomen cramping, fecal urgency and frequency
anemia, low albumin levels
diagnosis UC
stool culture ** (to exclude infectious diarrhea)
CBC, ESR, ANCA/ASCA, Albumin
Endoscopy
endoscopy evaluation of UC
location affected
appearance and biopsy for histology
ASCA
antibodies that correlate Crohn’s disease
ANCA
correlate with UC (cytoplasm of neutrophils)
diagnostic test in UC
colonoscopy and biopsy
crypt abscess, branching, atrophy
pseudopolyps, inflammatory changes SUPERFICALLY
UC classification based on stool frequency
<4 = mild >6 = severe
UC acute attack tx
protitis/proctosigmoiditis
5-ASA suppository (Mesalamine)
IF needed PO 5ASA or corticosteroid enema
UC acute attack tx
Mild/Mod UC
PO 5-ASA (Sulfasalazine)
no improvement in 5 wks = Budesonide (other corticosteroid)
If not working= immunomodulators
when to consider total colectomy in mild mod UC flare
immunomodulators dont provide improvement in 72 hrs OR dilation of colon is seen on serial XR
severe colitis tx
hospital admission, IVF, IV steroids, anti-TNF, surgical consult
indications for surgical management in UC
severe hemorrhage, perforation, carcinoma
fulminant colitis/toxic megacolon that fails to improve in 72 hrs
relative: refractory to steroids
surgical interventions in UC
colectomy + ileostomy
internal ileal pouch
total protocolectomy (can be curative)
complications with UC surgical management
pouchitis
tx= probiotics and intermittent ABC
maintenance therapy UC (steps)
- oral 5-ASA agent (Mesalamine, Sulfasalazine)
- immunomodulators (methotrexate)
- Anti-TNF inhibitors
indication for immunomodulators UC
> 2 relapses/yr
corticosteroid dependent disease
supportive UC tx
fiber supplements
limit gas producing veggies (beans) and caffeine
avoid antidiarrheal agents
fulminant toxic megacolon
rapidly progressing UC ove r1-2 weeks with signs of toxicity
fulminant megacolon presentation
fever
toxic appearing
hemorrhage = transfusion
hypovolemia
toxic megacolon management
IV abx (broad spectrum)
surgical consult for colectomy
UC prognosis
75-85% will relapse
20% will req. colectomy
increased risk of colon CA
increased mortality if presentation >60
