Mx of ulcerative collitis

Question 1

severity of UC is usually classified as

Answer 1

mild: < 4 stools/day, only a small amount of blood

moderate: 4-6 stools/day, varying amounts of blood, no systemic upset

severe: >6 bloody stools per day + features of systemic upset (pyrexia, tachycardia, anaemia, raised inflammatory markers)

Question 2

Inducing remission mild-to-moderate ulcerative colitis in proctitis ?

Answer 2

topical (rectal) aminosalicylate

Question 3

if remission is not achieved within 4 weeks, for mild-to-moderate ulcerative colitis in proctitis ?

Answer 3

add an oral aminosalicylate

Question 4

if remission is not achieved for mild-to-moderate ulcerative colitis in proctitis with topical and oral aminosalicylates then?

Answer 4

oral/topical corticosteroid

Question 5

inducing remssion in mild to moderate proctosigmoiditis and left-sided ulcerative colitis tx?

Answer 5

same as proctitis

however

if remission is not achieved within 4 weeks, add a high-dose oral aminosalicylate
OR switch to a high-dose oral aminosalicylate and a topical corticosteroid

if remission still not achieved stop topical treatments and offer an oral aminosalicylate and an oral corticosteroid

Question 6

inducing remission in mild to moderate extensive disease tx?

Answer 6

topical (rectal) aminosalicylate and a high-dose oral aminosalicylate

if remission is not achieved within 4 weeks, stop topical treatments and offer a high-dose oral aminosalicylate and an oral corticosteroid

Question 7

inducing remission in severe UC?

Answer 7

should be treated in hospital !

intravenous steroids are usually given first-line

intravenous ciclosporin may be used if steroid are contraindicated

if after 72 hours there has been no improvement, consider adding intravenous ciclosporin to intravenous corticosteroids or consider surgery

Question 8

Maintaining remission

Following a mild-to-moderate ulcerative colitis flare in proctitis and proctosigmoiditis

Answer 8

topical (rectal) aminosalicylate alone (daily or intermittent)
or
an oral aminosalicylate plus a topical (rectal) aminosalicylate (daily or intermittent)
or
an oral aminosalicylate by itself: this may not be effective as the other two options

Question 9

Maintaining remission

Following a mild-to-moderate ulcerative colitis flare

Answer 9

oral aminosalicylate

Question 10

Maintaining remission

Following a Following a severe relapse or >=2 exacerbations in the past year

Answer 10

oral azathioprine or oral mercaptopurine