UC Flashcards
TRUELOVE AND WITT’S CRITERIA FOR SEVERITY for UC what do you check for?
- Bowel movements
- Blood in stools
- Pyrexia (temperature greater than 37.8°C)
- Pulse rate greater than 90 bpm
- Anaemia (< 10g/100mL)
- Erythrocyte sedimentation rate (mm/hour)
What would a severe score look like in truelove and Witts criteria?
- 6 or more plus at least one of the features of systemic upset
- Visible blood
- Yes
- Yes
- Yes
- Above 30
Whats used to confirm diagnosis?
Colonoscopy, barium enema, and biopsy
What will a colonoscopy show?
continuous inflammation with an erythematous mucosa, loss of haustral markings, and pseudopolyps
What will a barium enema show?
loss of goblet cells, crypt abscess, and inflammatory cells
What will a biopsy show?
lead-piping inflammation, thumb-printing and pseudopolyps
Mild-moderate disease for Proctitis and proctosigmoiditis managemnet
Step 1 treatment aims to induce remission. If this does not work after 4 weeks, or symptoms worsen, move to step 2.
The first step in management for a moderate first presentation is to offer a topical aminosalicylate as a first-line treatment. If remission is not achieved within 4 weeks, consider adding an oral aminosalicylate.
Proctitis and proctosigmoiditis:
Step 1: Topical ASA or oral ASA.
Step 2: Consider adding oral prednisolone.
Mild-moderate disease for Left sided or extensive disease managemnt
Step 1: High dose oral ASA.
Step 2: Consider adding oral prednisolone
Acute severe disease mangement
Step 1: IV corticosteroids (if contraindicated or not tolerated, use IV ciclosporin).
Step 2: If no improvement in 72 hours or worsening symptoms, add IV ciclosporin
or consider surgery (if IV ciclosporin is contraindicated or not tolerated, consider infliximab)
What are the indications for emergency surgery?
Acute fulminant ulcerative colitis
Toxic megacolon who have little improvement after 48-72 hours of intravenous steroids
Symptoms worsening despite intravenous steroids
UC is most common for who?
Non smokers and Ex smokers
What is UC often associated with (disease in liver)
Primary sclerosing cholangitis (PSC)
= Autoimmune disorder
A 24-year-old doctor sees his GP owing to a two month history of bloody diarrhoea. He has been opening his bowels between two and four times a day and has, on two occasions, needed to urgently open his bowels during the night. This has been associated with abdominal discomfort, bloating and occasional tenesmus. He has had a similar episode in the past but this was much less severe. He has not travelled outside the UK for years. On examination, there is conjunctival pallor and angular stomatitis as well as tenderness in the left iliac fossa Which most useful initial test to inform further investigations?
Faecal calprotectin
A 54-year-old man with long-standing ulcerative colitis is seen in the Gastroenterology Clinic. His general practitioner has noticed that he has abnormal liver enzymes, and also that he has lost weight. What is the most likely diagnosis?
Biliary tract carcinoma
Surgery should be considered if patients fail to respond to rescue therapy within how many days
within 3
