UC Flashcards
Epidemiology of ulcerative colitis age? F:M?
30s
F>M
Causes of ulcerative colitis
Concordance = 10%
TH2-mediated
Protective factor against UC
smoking
Macroscopic changes of ulcerative colitis
- Rectum + colon ± backwash ileitis ulcers,
- Contiguous
- no strictures
Microscopic changes in ulcerative colitis
- Mucosal or Crypt inflammation
- shallow and broad ulcers
- marked pseudopolyps
Symptoms of ulcerative colitis
- Diarrhoea
- Blood ± mucus PR
- Abdominal discomfort
- Tenesmus, faecal urgency
Abdominal Signs of ulcerative colitis
- fever
- tender, bloated
Imaging investigations for ulcerative colitis
AXR: megacolon (>6cm), wall thickening
Complications of ulcerative colitis?
- toxic megacolon
- bleeding
- malignacny (CRC or cholangiocarcinoma)
Ba enema findings for ulcerative colitis?
- Lead-pipe: no haustra
- Thumbprinting: mucosal thickening
- Pseudopolyps
Management of Severe ulcerative colitis?
- NBM +fluids
- Hydrocortisone: IV 100mg QDS + PR
If no improvement after the initial management of severe ulcerative colitis attack, what is the treatment?
- On day 3, stool freq >8 or CRP >45 predicts 85% chance of colectomy
- ciclosporin, infliximab or visilizumab (anti-T cell)
Secondary management of severe ulcerative colitis after improvement post-primary care?
- Switch to oral pred + a 5-ASA
- Taper pred after full remission
Oral therapy for ulceratice colitis
- 1st line: 5-ASAs (eg sulfasalazine)
- 2nd line: prednisolone
Drugs for maintaining remission in ulceratice colitis
1st line: 5-ASAs, sulfasalazine or mesalazine
2nd line: Azathioprine or 6-mercaptopurine
3rd line: Infliximab / adalimumab
Indications for emergency surgery in ulceratice colitis
- Toxic megacolon
- Perforation
- Massive haemorrhage
- Failure to respond to medical Rx
Emergency surgical options available to ulceratice colitis patients?
Total / subtotal colectomy ̄c end ileostomy ± mucus fistula+
Followed after ~3mo by either
a. Completion proctectomy + Ileal-pouch analanastomosis (IPAA) or end ileostomy
b. Ileorectal anastomosis (IRA)
c. Panproctocolectomy + permanent end ileostomy
Elective surgery indications for ulceratice colitis?
- Chronic symptoms despite medical therapy
- Carcinoma or high-grade dysplasia
Abdominal complications of surgery on ulceratice colitis?
- SBO- Anastomotic stricture
- Pelvic abscess
Stoma complications of surgery on ulceratice colitis?
retraction,
stenosis,
prolapse,
dermatitis
Pouch complications of surgery on ulceratice colitis?
- Pouchitis (50%)
- ↓ female fertility
- Faecal leakage
