UC Flashcards

1
Q

What is it?

What happens to the colonic mucosa?

Where does it never go past?

What is it never?

What happens if it is severe? - 2

A

Relapsing and remitting IBD -
A continuous area of inflammation in rectum +/- colon

Colonic mucosa - inflamed and friable

Ileocaecal valve

Transmural

Inflammation and ulceration

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2
Q

What 2 age ranges is it more common in?

A

15-25 yrs
55-65 yrs

BIMODAL distribution

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3
Q

Presentation - Intestinal:

Describe the diarrhoea?

1 other symptom similar to period pains?

2 rectal symptoms are urgency and tenesmus****. Define them?

How does it tend to present compared to Crohn’s?

A

D - bloody in 75% of cases - may contain mucus *****

Cramps

Urgency occurs when the arrival of faeces in the rectum causes strong contractions and precipitate anal relaxation. In that situation, continence can only be maintained by the conscious contraction of the external anal sphincter.

A continual or recurrent inclination to evacuate the bowels, caused by a disorder of the rectum or other illness.

Gradually

UC - mucus in stool and tenesmus is the main difference

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4
Q

Presentation - UC Attacks:

Symptoms - 3

What may trigger it?

A

Tender distended abdo
Fever
Anorexia and weight loss

Infection

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5
Q

Presentation - Non-intestinal:

Eyes - 3

Mucosa of mouth - 1

Nails - 1

You also get erythema nodosum and pyoderma gangrenosum. Define both of them? - SAME IN CROHNS

A

Uveitis
Episcleritis
Conjunctivitis

Aphthous ulcers

Clubbing

A type of panniculitis, an inflammatory disorder affecting subcutaneous fat. It presents as tender red nodules on the anterior shins. Less commonly, they affect the thighs and forearms

A rare, inflammatory skin disease where painful pustules or nodules become ulcers that progressively grow.

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6
Q

Presentation - Hepatobiliary:

You also get primary sclerosing cholangitis. Define it? - UC ONLY

3 other hepatobiliary diseases that may present in conjunction with UC? - SAME IN CROHNS

A

A long-term progressive disease of the liver and gallbladder characterized by inflammation and scarring of the bile ducts which normally allow bile to drain from the gallbladder.

Chronic hepatitis
NAFLD
Cirrhosis

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7
Q

Risk factors:

One normal risk factor for other diseases but not for UC

One main one for UC

What gene increases the risk?

A

Not smoking - smoking makes it better for some reason

FH

HLA-B27

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8
Q

Investigations - Bloods - Why do you do the following:

  • FBC - 2
  • 2 other things you look for in the blood that could indicate inflammation
  • CRP/ESR
  • U&E, Mg and Ca
  • LFT
  • Antibodies for UC only
A

FBC - Haemoglobin and haematinics (iron, folate and B12) - patients usually have anaemia

Raised platelets
Low albumin

CRP/ESR - raised in inflammation

Nutritional deficiencies

Hepatobiliary disease

pANCA - antibodies (70% accurate in UC)

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9
Q

Investigations - stool:

What can be done to the stool to rule out infection?

Marker for inflammation and why it is used?

One important bacteria that may cause inflammation or colon and diarrhoea?

A

Culture to rule out infection

Faecal calprotectin

C. diff toxin

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10
Q

Investigations - endoscopy:

What type of endoscopy is used if acute and if chronic?

What would you see on endoscopy?

A

Limited flexible sigmoidoscopy with biopsy

Full colonoscopy

Crypt architecture changes including cryptitis and crypt abscesses

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11
Q

Investigations - AXR:

What may it show?

A

Perforation
Gross dilatation in a flare-up
Toxic megacolon (>6cm in transverse colon)

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12
Q

Management: GOAL IS TO MAINTAIN REMISSION

How do you assess the severity of UC?

A

Truelove and Witt’s Criteria

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13
Q

Management - Mild-moderate:

What is the first line Rx if distal disease (descending colon, rectosigmoid)?

What if it is more extensive (so proximal or refractory)?

What is second line?

A

5-ASA - mesalazine PR (enema)

5-ASA - mesalazine but PO

Add prednisolone PO + PR or Prednisolone PR

(PR - topical steroid foams or retention enemas)

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14
Q

Management - Severe

When is it classed as severe?

What should be done first?

What medication should be administered straight after and by what route?

What 2 medications can be given to induce remission for refractory disease (keeps coming back/unmanageable)?

What permanent solution is there if refractory (keeps coming back/unmanageable)? - 3

A

> 6 stools per day (usually bloody) + SYSTEMICALLY UNWELL (fever, tachycardia)

Admit and fluid resus

Corticosteroids IV

Ciclosporin - immunosuppressor
Biologics - Infliximab

Subtotal colectomy - avoided by above - done if they don’t improve

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15
Q

Management - Remission

What should be given if UC is rectosigmoid?

What should be given after a severe attack or if needed steroids twice in a yr?

A

Mesalazine PO + PR or PR - same as first-line for mild-moderate attack

Immunusuppressors:

  • Azathioprine
  • Mercaptopurine
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16
Q

Biologics and Janus Kinase Inhibitors:

Why are they used?

Give some examples of Anti-TNFα?

A

For induction and maintenance in refractory moderate-severe disease.

Infliximab
Adalimumab
Golimumab

17
Q

5-ASA:

What are they?

Side effects?

Monitoring required?

A

Aminosalicylates are compounds that contain 5-aminosalicylic acid (5-ASA) and reduce inflammation in the lining of the intestine. Some forms may also reduce joint inflammation. While any medication has potential risks (see below), 5-ASA medications are often very well tolerated and have not been associated with an increased risk of infection or cancer. These medications are not immunosuppressants.

Rash
Haemolysis
Hepatitis

U&E
FBC - haemolysis

18
Q

Surgical:

The percentage that need surgery?

Indications - 3

Elective surgery:

Proctocolectomy with ileo-anal pouch anastomosis or end ileostomy:

  • Define?
  • Why is a stoma better than a pouch?
  • Complications of pouch
A

30%

Medically refractory chronic or acute UC
Toxic megacolon or perforation
Dysplasia or malignancy

Removal of whole bowel and end of the small bowel is connected to the anus or a stoma bag is used

Technically harder to do
Higher morbidity in terms of functionality and quality of life

Pouchitis
Urgency
Impaired fertility in women due to adhesions
Nocturnal seepage

19
Q

Surgical - Acute:

What is a subtotal colectomy?

Complications

A

Remove everything but rectum with end ileostomy and long rectal stump

Sepsis
Poor healing due to high dose steroids

20
Q

Complications of UC:

2 complications which need emergency surgery

A complication of inflammation generally

What does have UC or Crohns increase your risk of?

A

Perforation
Toxic megacolon

Cancer

VTE - PE and DVT