IBD; ulcerative colitis

Question 1

What is Ulcerative colitis

Answer 1

Mucosal inflammation in colon and rectum

Question 2

Symptoms

Answer 2

Rotates between flare up and remission
1= bloody diarrhoea (can contain mucus or pus)
2) abdominal pain lower, urgent need to defecate
3) acute flare up - mouth ulcers sore skin, weight loss , fatigue, arthritis

Question 3

Long term Complications

Answer 3

Colorectal cancer
Secondary osteoporosis (dietary change or long term steroid)
VTE
Toxic mega colon

Question 4

C/I

Answer 4

Loperamide/ codeine I.e.
Anti motility or anti spasmodic Drug contraindicated risK of paralytic ileum= toxic megaColon

Question 5

Treatment depends on location

Answer 5

Extensive colon oral
Left sided colitis (distal)= liquid enema
Proctosigmoiditis = Foam enema
Proctitis (rectum)= suppository

For proctosigmoid / proctitiss - foam and suppository easier retained than liquid

Question 6

Treatment P/PS mild- mod uc

Answer 6

1st line = rectal aminosalicylate
2nd line= Rectal corticosteroid or oral prednisolone

Question 7

Treatment LSC/extensive

Answer 7

1st = high dose oral aminosalicylate + rectal aminosalicylate or oral betametasone if necessary
Alt= oral pred only

Question 8

Subacute moderate to severe UC

Answer 8

Give oral prednisolone
Alt= monoclonal antibody

Question 9

Initial tx failure in Acute mild to mod UC - all extents

Answer 9

Give oral pred (if no improve with aminosalicylate after 4 weeks)
2nd line oral tacrolimus (if symptoms don’t improve 2-4 weeks)

Question 10

Medical emergency severe acute UC

Answer 10

A= give if steroids +assess need surgery
Alternative - iv ciclosporin Or surgery
B = If symptoms worse/ don’t improve 72hrs
Give iv ciclosporin +iv steroid Or surgery
Alternative to ciclosporin = infliximab

Question 11

Why aminosalicylates for maintenance tx over steroids

Answer 11

Steroids have too many s/e

Question 12

Maintentance p/ ps

Answer 12

Rectal aminosalicylate +oral aminosalicylate (oral aminosalicylate can be used alone but less effective)

Question 13

Maintenance tx of LSC/extensive

Answer 13

Low dose aminosalicylate oral (single daily dose over multiple dose, this has s/e)

Question 14

If two or more flare ups requiring surgery in 12 months Requiring steroids, remission not treated ted by aminosalicylste ,or after severe flare (in extensive or LSC

Answer 14

Oral azathiprine or mercaptopurine

However, if in acute flare up monoclonal antibodies were effective this can be continued