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A. MLA Map Paediatrics > IBD - Ulcerative Colitis > Flashcards

IBD - Ulcerative Colitis Flashcards

1
Q

Where in the GIT does ulcerative colitis affect?

1 - rectum only
2 - mouth to anus
3 - large bowel only
4 - small bowel only

A

3 - large bowel only

  • up to ileocaecal valve
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2
Q

Ulcerative colitis is one of the 2 types of inflammatory bowel disease that can anywhere in the large bowel. Does ulcerative colitis affect the GI tract continuously or is it patchy?

A
  • continuous inflammatory condition
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3
Q

In ulcerative colits what ages are most at risk?

1 - children 16-25 y/o
2 - adults 20-40 y/o
3 - adults at 40- 60 y/o
4 - adults >65 y/o

A

2 - adults 20-40 y/o

  • biomodal
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4
Q

What is the prevalence (number of people with disease at a specific time) of UC in the western world?

1 - 0.1 / 100,000
2 - 1 / 100,000
3 - 10-20 / 100,000
4 - 100-200 / 100,000

A

4 - 100-200 / 100,000

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5
Q

What is the incidence (number of new cases of a disease at a specific time) of crohns disease in the western world?

1 - 0.1 / 100,000
2 - 1 / 100,000
3 - 10-20 / 100,000
4 - 100-200 / 100,000

A

3 - 10-20 / 100,000

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6
Q

In ulcerative colits are men or women more at risk of developing the disease?

A
  • women
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7
Q

In ulcerative colits is smoking associated with the disease?

A
  • no
  • suggested to be protective
  • smoking cessation can cause a relapse in symptoms
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8
Q

What from of medication has been linked with ulcerative colitis?

1 - paracetamol
2 - ibuprofen
3 - lithium
4 - metformin

A

2 - ibuprofen
- NSAIDs have been linked to flare ups

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9
Q

In ulcerative colitis is there a genetic risk of developing the disease?

A
  • yes
  • BUT so many hard to know which
  • higher risk in monozygotic twins
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10
Q

Is ulcerative colitis transmural or mucosal/submucosal?

A
  • mucosal/submucosal
  • can cause the appearance of pseudopolpys
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11
Q

In the image below, which is crohns disease and which is ulcerative colitis?

A
  • left = crohns with deep but patchy inflammation
  • right = ulcerative colitis with shallow systemic inflammation
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12
Q

A stricture is a narrowing of a hollow passage. Are these common in crohns disease and ulcerative colitis?

A
  • CD = common and multiple
    common in CD due to the fibrosis of the GIT walls that causes narrowing
  • UC = rare
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13
Q

Fistula is abnormal opening or passage between two organs lined by epithelial cells. Are these common in crohns and ulcerative colitis?

A
  • CD = common
  • UC = rare
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14
Q

Perianal disease is essentially damage and/or inflammation around the anus. Is this common in crohns disease and ulcerative colitis?

A
  • CD = common
  • UC = rare
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15
Q

Are GIT obstructions common in crohns and ulcerative colitis?

A
  • CD = incomplete are common due to fibrosis and stricutres
  • UC = rare
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16
Q

Reorganise the steps of pathophysiology of UC?

1 - intact oedematous mucosa appear as pseudopolpys
2 - colonic mucosa becomes acutely inflamed
3 - small crypt abscesses form
4 - superficial mucosa is sloughed off creating superficial ulcers
5 - neutrophils collect in lamina propria and tubular colonic glands

A

2 - colonic mucosa becomes acutely inflamed

5 - neutrophils collect in lamina propria and tubular colonic glands

3 - small crypt abscesses form

4 - superficial mucosa is sloughed off creating superficial ulcers

1 - intact oedematous mucosa appear as pseudopolpys

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17
Q

How long do inflammatory episodes last in UC?

1 - hours to days
2 - days to weeks
3 - days to months
4 - years

A

3 - days to months

  • in between episodes, called quiescence, the mucosa is able to regenerate
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18
Q

During quiescence, the mucosa is able to regenerate, but what happens to the lamina propria during quiescence?

1 - regenerates like mucosa
2 - remains swollen with lymphocytes and plasma cells
3 - likely to perforate during this time due to inflammation

A

2 - remains swollen with lymphocytes and plasma cells

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19
Q

Following chronic UC, dysplastic changes can be identified on histology. Multiple bouts of inflammation in the presence of dysplastic changes increases the risk of what in patients with UC?

1 - developing crohns
2 - perforation
3 - strictures
4 - adenocarcinoma

A

4 - adenocarcinoma

  • carcinoma of glandular cells
  • 2% at 10 years from diagnosis
  • 8% at 20 years from diagnosis
  • 18% at 30 yeara from diagnosis
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20
Q

When trying to remember all the presentations of ulcerative colitis we can use the mnemonic U – C – CLOSEUP. What does the C relate to?

1 - CRP is increased
2 - continuous inflammation
3 - cachexia in patient
4 - cor pulmonale

A

2 - continuous inflammation

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21
Q

When trying to remember all the presentations of ulcerative colitis we can use the mnemonic U – C – CLOSEUP. What does the L relate to?

1 - light affected
2 - lymphoma
3 - liver affected
4 - limited to colon and rectum

A

4 - limited to colon and rectum

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22
Q

When trying to remember all the presentations of ulcerative colitis we can use the mnemonic U – C – CLOSEUP. What does the O relate to?

1 - open bowels less
2 - only superficial mucosa affected
3 - outer layers of GIT not affected
4 - o negative blood types have increased risk

A

2 - only superficial mucosa affected

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23
Q

When trying to remember all the presentations of ulcerative colitis we can use the mnemonic U – C – CLOSEUP. What does the S relate to?

1 - smoking is protective
2 - superficial layers of GIT not affected
3 - sinus nodes are damaged
4 - sickle cell disease is increased

A

1 - smoking is protective

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24
Q

When trying to remember all the presentations of ulcerative colitis we can use the mnemonic U – C – CLOSEUP. What does the E relate to?

1 - eating is impossible
2 - endoscopy can diagnose
3 - excrete blood and mucus
4 - elevated neutrophils

A

3 - excrete blood and mucus

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25
Q

When trying to remember all the presentations of ulcerative colitis we can use the mnemonic U – C – CLOSEUP. What does the U relate to?

1 - unilateral impact on colon
2 - unintentional weight gain
3 - undiagnosed until >40 y/o
4 - use aminosalicylates

A

4 - use aminosalicylates

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26
Q

When trying to remember all the presentations of ulcerative colitis we can use the mnemonic U – C – CLOSEUP. What does the P relate to?

1 - Primary Sclerosing Cholangitis
2 - PPI increase risk
3 - Patency is lost in the colon
4 - pleural effusion occur more often

A

1 - Primary Sclerosing Cholangitis

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27
Q

Which of the following is NOT a typical symptom of UC?

1 - episodic or chronic diarrhoea
2 - blood and mucus in stool
3 - crampy/abdominal discomfort
4 - abdominal mass
5 - increased bowel frequency
6 - fever/malaise/anorexia / weight loss
7 - pain in left lower quadrant

A

4 - abdominal mass

  • common in CD
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28
Q

Which of the following are generally present in a patient with an acute flair up of the UC?

1 - fever
2 - bradycardia
3 - tender abdomen
4 - distended abdomen

A

2 - bradycardia

  • normally tachycardia
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29
Q

In addition to the generic GI manifestations of UC, there are other extra intestinal symptoms. Which of the following is NOT a typical extra intestinal symptom of UC?

1 - clubbing
2 - joint problems
3 - erythema nodosum
4 - conjunctivitis
5 - large joint arthritis
6 - perianal abscess

A

6 - perianal abscess

  • large joint arthritis includes ankylosing spondylitis and sacroiliacitis
30
Q

In patients with UC what do most people present with during an acute attack?

1 - mild isolated discomfort throughout whole abdomen
2 - blood stained stools with mucus
3 - pain in the RIF
4 - fever and tachycardia

A

2 - blood stained stools with mucus

  • blood and mucus from sloughed off mucosa
31
Q

The typical presentation of a patent with suspected UC is a young adults, several weeks of loose stools with streaky blood and mucus, often starting with an attack of gastroenteritis or travellers diarrhoea that fails to clear. What are the 2 inflammatory markers that are typically raised in UC?

1 - CRP
2 - creatine kinase
3 - ESR
4 - IL-6

A

1 - CRP

3 - ESR

32
Q

What marker that is present and released from the intestinal cells can be used to screen for ulcerative colitis?

1 - creatine kinase
2 - troponin
3 - faecalprotectin
4 - all of the above

A

3 - faecalprotectin

33
Q

The typical presentation of a patent with suspected UC is a young adults, several weeks of loose stools with streaky blood and mucus, often starting with an attack of gastroenteritis or travellers diarrhoea that fails to clear. An abdominal examination is often unremarkable, so what it often the 1st line investigation if a patient has an acute presentation?

1 - colonoscopy
2 - sigmoidoscopy
3 - CT scan
4 - MRI scan

A

2 - sigmoidoscopy

  • accompanied by rectal examination and biopsy can be taken if useful
  • colonoscopy when disease is stable to assess extent of the disease to reduce risk of perforation
34
Q

The typical presentation of a patent with suspected UC is a young adult, several weeks of loose stools with streaky blood and mucus, often starting with an attack of gastroenteritis or travellers diarrhoea that fails to clear. An abdominal examination is often unremarkable, so what it often the 1st line investigation if a patients UC is stable?

1 - colonoscopy
2 - sigmoidoscopy
3 - CT scan
4 - MRI scan

A

1 - colonoscopy

  • used to assess extent of disease involvement
35
Q

In UC the term goblet cell depletion is used. What is this?

1 - goblet cell number decreases and so does mucus production
2 - goblet cell number remains but are unable to secrete mucus
3 - all goblet cells are wiped out

A

1 - goblet cell number decreases and so does mucus production
- this is because the mucosa and submucosa are affected in UC

36
Q

When trying to diagnose a patient with UC, a CT scan is normally performed in acute disease. What is often the most common finding on CT in patients with UC?

1 - fibrotic walls and strictures
2 - transmural ulcers
3 - multiple fistulas
4 - atrophy or complete loss of haustra

A

4 - atrophy or complete loss of haustra

37
Q

In a patient with suspected UC, stool samples need to be analysed to rule out parasitic, bacterial or cytomegalovirus causes. How may separate samples need to be analysed?

1 - just one
2 - 3
3 - 5
4 - 6

A

2 - 3

  • important as infections form any of these can present with similiar symptoms
38
Q

In UC patients have blood and mucus in their stools. Why do these patients experience diarrhoea and even incontinence?

1 - inflammation signals GIT to release water into lumen
2 - mucosa and submucosa are damaged so unable to reabsorb fluid appropriately
3 - hypertrophy of mucosa due to inflammation and water cannot be absorbed

A

2 - mucosa and submucosa are damaged so unable to reabsorb fluid appropriately

  • patients may pass <20 stools
39
Q

What % of patients with UC will require surgery?

1 - 0.2%
2 - 2%
3 - 20%
4 - 40%

A

3 - 20%

40
Q

In ulcerative colitis what is the lifetime risk of a colectomy (complete removal of colon)?

1 - 2-3%
2 - 20-30%
3 - 50-70%
4 - >70%

A

2 - 20-30%

41
Q

Is UC curable?

A
  • yes
  • removal of large bowel is considered curative
42
Q

Which scoring system is used to identify the severity of UC?

1 - CURB score
2 - GCS
3 - modified Glasgow scale
4 - truelove and witts scale

A

4 - truelove and witts scale

43
Q

Patients with UC can develop fulminant colitis. What is this?

1 - erosion of all layers of the large bowel
2 - spread of UC to small bowel
3 - systemic inflammation of large bowel with sores
4 - severe inflammation in rectum only

A

3 - systemic inflammation of large bowel with sores

  • most severe form of UC
  • can lead to toxic megacolon (UC is the most common cause)
44
Q

In a patient with fulminant colitis, which is a medical emergency, they can develop significant symptoms. Which of the following is NOT a typical presentation?

1 - prostrated (very weak)
2 - over hydrated
3 - blood loss
4 - electrolyte disturbance

A

2 - over hydrated

  • patient will be dehydrated
  • need urgent resuscitation
45
Q

Toxic megacolon, which is severe swelling and inflammation of the large bowel can occur UC. What is the clinical diagnosis?

1 - dilated colon >3cm
2 - dilated colon >9cm
3 - dilated colon >6cm
4 - dilated colon >12cm

A

3 - dilated colon >6cm

  • colon is normally 6cm
  • needs to be in the presence of pyrexia and tachycardia
  • SI is 3cm and 6cm for caecum
46
Q

In a patient who needs surgery for UC, they have 3 main options. One of these is a subtotal colectomy with ileostomy. What is this?

1 - majority of colon removed, except for rectal stump
2 - removal of whole colon and rectum with permanent ileostomy
3 - removal of colon and rectus mucosa with pouch from terminal ileum. The pouch is then anastomosed with anal canal

A

1 - majority of colon removed, except for rectal stump

47
Q

In a patient who needs surgery for UC, they have 3 main options. One of these is a protocolrctomy with permanent ileostomy. What is this?

1 - majority of colon removed, except for rectal stump
2 - removal of whole colon and rectum with permanent ileostomy
3 - removal of colon and rectus mucosa with pouch from terminal ileum. The pouch is then anastomosed with anal canal

A

2 - removal of whole colon and rectum with permanent ileostomy

48
Q

In a patient who needs surgery for UC, they have 3 main options. One of these is a restorative protocolectomy with permanent ileostomy. What is this?

1 - majority of colon removed, except for rectal stump
2 - removal of whole colon and rectum with permanent ileostomy
3 - removal of colon and rectus mucosa with pouch from terminal ileum. The pouch is then anastomosed with anal canal

A

3 - removal of colon and rectus mucosa with pouch from terminal ileum. The pouch is then anastomosed with anal canal

49
Q

Which autoimmune disease is most common in patients with IBD?

1 - sclerosing cholangitis
2 - multiple sclerosis
3 - rheumatoid arthritis
4 - type 1 diabetes

A

1 - sclerosing cholangitis

  • ankylosing spondylitis and sacroilitis can also present
50
Q

In patients with ulcerative colitis what % of patients will go into remission (R), maintain with symptoms (M) and progress (P)?

1 - R = 10%, M = 10%, P = 30%
2 - R = 30%, M = 33.3%, P = 10%
3 - 33.3% for Rm M and P

A

3 - 33.3% for R, M and P

51
Q

In a patient that needs acute management of ulcerative colitis, which of the following should be given 1st?

1 - oral prednisolone
2 - low molecular weight heparin
3 - IV hydrocortisone
4 - mesalazine

A

3 - IV hydrocortisone

52
Q

In a patient that needs acute management of ulcerative colitis, they are given IV hydrocortisone. They are also given low molecular weight heparin. Why is this?

1 - reduce the risk of bleeding
2 - increase blood flow to inflamed tissue
3 - increased risk of DVT
4 - reduce blood loss in stool

A

3 - increased risk of DVT
- reduces the risk of DVT
- does not increase blood loss in stool

53
Q

When treating UC we use the pyramid treatment approach. Which of the following should be prescribed 1st in a patient with mild UC in an attempt to maintain remission?

1 - biologicals
2 - thiopurines
3 - aminosalicylic acid (mesalazine)
4 - corticosteroids

A

3 - aminosalicylic acid (mesalazine)

  • generally given PR 1g daily
  • Mesalazine and Sulfasalazine are the 2 core drugs
54
Q

Which 2 of the following are the core aminosalicylic acids we need to be aware of?

1 - Mesalazine
2 - Sulfasalazine
3 - Mercaptopurine
4 - Tocilizumab

A

1 - Mesalazine

2 - Sulfasalazine

55
Q

When treating IBD, we use the pyramid which includes Mesalazines (bottom, so first line), Thiopurines (middle) and Biologics (top). Mesalazines are the first line treatment, but are they used in both ulcerative colitis and crohns disease?

A
  • no
  • ulcerative colitis only
56
Q

When treating UC we use the pyramid treatment approach. 1st line management is aminosalicylic acid. If an additional treatment is needed to help induce remission, which of the following is added to aminosalicylic acid?

1 - biologicals
2 - thiopurines
3 - purine analogues
4 - corticosteroid

A

4 - corticosteroid
- used to alleviate acute flare ups

  • prednisolone 40mg/day for 1 week tapering 5mg/week for 7 weeks
  • then switch to aminosalicylic acid, specifically Mesalazine
57
Q

When treating UC we use the pyramid treatment approach. Which of the following should be prescribed 1st in a patient with severe UC?

1 - hydrocortisone or methylprednisolone
2 - prednisolone, methylprednisolone or biologics
3 - prednisolone, methylprednisolone or hydrocortisone
4 - mesalazine, biologics, or hydrocortisone

A

1 - hydrocortisone (H) or methylprednisolone (M)

  • H = 100mg/6h
  • M = 40mg/12h
58
Q

Mesalazine is the first line of treatment for ulcerative colitis and is a 5–aminosalicyclic acids ( 5-ASAs). What is the mechanism of action?

1 - down-regulates inflammatory genes
2 - inhibits immune cells
3 - binds and inhibits neutrophils
4 - suppresses bone marrow and immune cells

A

1 - down-regulates inflammatory genes

  • poorly digested and metabolised in GIT by bacteria
  • topical effects in colon only
  • absorbed by epithelial cells and down regualates inflammatory genes
59
Q

If a patient has rectal inflammation or a severe flair up of UC, would we prescribe:

  • corticosteroids (prednisolone, methylprednisolone or hydrocortisone)
  • 5–aminosalicyclic acids (5-ASAs) (mesalazines or sulfasalazines)
A
  • corticosteroids (prednisolone, methylprednisolone or hydrocortisone)
60
Q

If a patient is given steroids, they are often prescribed other medications to combat the potential side effects of these medications. Which of the following is NOT one of the medications?

1 - Ca2+ / vit D
2 - proton pump inhibitor
3 - beta blocker
4 - glucose management

A

3 - beta blocker

  • Ca2+ / vit D to protect bones
  • proton pump inhibitor to protect stomach lining
  • glucose management to manage potential risk in blood glucose
61
Q

If a patient has rectal inflammation or a severe flair up of UC, we would prescribe corticosteroids (prednisolone, methylprednisolone or hydrocortisone). However, if these fail to work, which 2 of the following immunomodulation could we prescribe?

1 - azathioprine
2 - cyclosporin and methotrexate
3 - methotrexate and azathioprine
4 - Retuximab

A

1 - azathioprine
- this is a thiopurine

  • ciclosporin could be given if azathioprine is not effective
  • these are immunosuppressive drugs
62
Q

If a patient has rectal inflammation or a severe flair up of UC, that is not responding to steroids and they are unable to take immunomodulators, they may be prescribed biological therapy. Which 2 of the drugs below may be prescribed?

1 - cyclosporin and azathioprine
2 - infliximab and adalimumab
3 - cyclosporin and infliximab
4 - rituximab and adalimumab

A

2 - infliximab and adalimumab

63
Q

When trying to maintain remission in a patient with ulcerative colitis who has had 2 flair ups in the last 12 months, which 2 drugs can be used?

1 - cyclosporin
2 - azathioprine
3 - infliximab
4 - mercaptopurine

A

2 - azathioprine
4 - mercaptopurine

  • one or the other but not both
64
Q

Patients with acute ulcerative colitis are at risk of embolus from DVTs. What drug are they prescribed to reduce the risk of this?

1 - Heparin
2 - Dalteparin
3 - Edoxaban
4 - Apixaban

A

2 - Dalteparin

  • low molecular weight heparin
  • could also prescibre Tinzaparin or Enoxaparin
65
Q

What is inflammation of the rectus called?

1 - rectitis
2 - analitis
3 - proctitis

A

3 - proctitis

  • proc = greek for anus
  • itis = inflammation
66
Q

What is ulcerative colitis called when it affects the whole large intestines?

1 - colitis
2 - mega toxic colon
3 - pancolitis

A
  • pancolitis
67
Q

What is the second line treatment for crohns, and the final line treatment for ulcerative colitis?

A
  • biologics
68
Q

When using medication for IBD, such as Mesalazines, Thiopurines and Biologics, instead of jumping between these 3 medication types, patients can often be prescribed something in between which can help them get into remission, what is this?

A
  • corticosteroids
69
Q

Thiopurines have a triomodal distribution of activity, what does this mean?

A
  • effectiveness is divided into threes
  • 1/3 will have no effect
  • 1/3 will have low/moderate effect
  • 1/3 will have normal/large effect
70
Q

Biologics are the final drug that can be prescribed to patients with IBD if other treatments have failed. What was the first biologic used to treat IBD?

A
  • anti TNF-a
  • 60% effective helping IBD remission

A. MLA Map Paediatrics (61 decks)

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