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MRCS med school > UC > Flashcards

UC Flashcards

1
Q

Epidemiology of ulcerative colitis age? F:M?

A

30s

F>M

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2
Q

Causes of ulcerative colitis

A

Concordance = 10%

TH2-mediated

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3
Q

Protective factor against UC

A

smoking

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4
Q

Macroscopic changes of ulcerative colitis

A
  • Rectum + colon ± backwash ileitis ulcers,
  • Contiguous
  • no strictures
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5
Q

Microscopic changes in ulcerative colitis

A
  • Mucosal or Crypt inflammation
  • shallow and broad ulcers
  • marked pseudopolyps
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6
Q

Symptoms of ulcerative colitis

A
  • Diarrhoea
  • Blood ± mucus PR
  • Abdominal discomfort
  • Tenesmus, faecal urgency
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7
Q

Abdominal Signs of ulcerative colitis

A
  • fever
  • tender, bloated
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8
Q

Imaging investigations for ulcerative colitis

A

AXR: megacolon (>6cm), wall thickening

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9
Q

Complications of ulcerative colitis?

A
  1. toxic megacolon
  2. bleeding
  3. malignacny (CRC or cholangiocarcinoma)
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10
Q

Ba enema findings for ulcerative colitis?

A
  • Lead-pipe: no haustra
  • Thumbprinting: mucosal thickening
  • Pseudopolyps
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11
Q

Management of Severe ulcerative colitis?

A
  1. NBM +fluids
  2. Hydrocortisone: IV 100mg QDS + PR
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12
Q

If no improvement after the initial management of severe ulcerative colitis attack, what is the treatment?

A
  • On day 3, stool freq >8 or CRP >45 predicts 85% chance of colectomy
  • ciclosporin, infliximab or visilizumab (anti-T cell)
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13
Q

Secondary management of severe ulcerative colitis after improvement post-primary care?

A
  • Switch to oral pred + a 5-ASA
  • Taper pred after full remission
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14
Q

Oral therapy for ulceratice colitis

A
  • 1st line: 5-ASAs (eg sulfasalazine)
  • 2nd line: prednisolone
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15
Q

Drugs for maintaining remission in ulceratice colitis

A

1st line: 5-ASAs, sulfasalazine or mesalazine

2nd line: Azathioprine or 6-mercaptopurine

3rd line: Infliximab / adalimumab

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16
Q

Indications for emergency surgery in ulceratice colitis

A
  • Toxic megacolon
  • Perforation
  • Massive haemorrhage
  • Failure to respond to medical Rx
17
Q

Emergency surgical options available to ulceratice colitis patients?

A

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

18
Q

Elective surgery indications for ulceratice colitis?

A
  • Chronic symptoms despite medical therapy
  • Carcinoma or high-grade dysplasia
19
Q

Abdominal complications of surgery on ulceratice colitis?

A
  • SBO- Anastomotic stricture
  • Pelvic abscess
20
Q

Stoma complications of surgery on ulceratice colitis?

A

retraction,

stenosis,

prolapse,

dermatitis

21
Q

Pouch complications of surgery on ulceratice colitis?

A
  • Pouchitis (50%)
  • ↓ female fertility
  • Faecal leakage

MRCS med school (44 decks)

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