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Gastrointestinal > Ulcerative Colitis > Flashcards

Ulcerative Colitis Flashcards

1
Q

What is ulcerative colitis?

A

Relapsing remitting inflammatory disorder of the colonic mucosa

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2
Q

What is the pneumonic for features of UC?

A

CLOSE UP

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3
Q

What does CLOSE UP stand for?

A 
C- Continuous inflammation 
L- Limited to colon and rectum 
O- Only superficial mucosa affected 
S- Smoking is preventative
E- Excrete blood and mucus 
U- Use aminosalicylates 
P- Primary sclerosing cholangitis
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4
Q

When does UC usually develop before?

A

Before the age of 34

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5
Q

How does the inflammation in the colon present?

A

One continuous band of inflammation

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6
Q

How does UC usually present?

A

Diarrhoea
Abdominal pain-LLQ
Weight loss- Due to abdo pain

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7
Q

What does the diarrhoea usually include?

A

Blood and Mucus

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8
Q

When does the abdominal pain usually occur?

A

After eating

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9
Q

Where does the abdominal pain usually occur?

A

In the LLQ

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10
Q

Why does a patient tend to lose weight with UC?

A

Abdominal pain which comes on after eating

Patient tends to avoid eating

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11
Q

What is the main investigation for UC?

A

Endoscopy and biopsy

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12
Q

What would you see on colonoscopy and biopsy?

A
  • No inflammation beyond the submucosa
  • Pseudopolyps (superficial ulceration)
  • Depletion of goblet cells
  • Continuous disease- no skip lesions
  • Crypt abscesses (neutrophils migrate to wall)
  • Drainpipe colon (colon narrowed and short)
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13
Q

What else can be used to diagnose UC?

A
  • p-ANCA positive
  • Faecal calprotectin
  • Barium enema- loss of haustrations
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14
Q

How often is P-ANCA positive?

A

70% of cases

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15
Q

What are possible complications of UC?

A

Toxic megacolon
Fissures
Abscess

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16
Q

What is used to induce remission in mild disease?

A

Aminosalicylates- Mesalazine

17
Q

What would you add if aminosalicylates weren’t controlling the disease?

A

Prednisolone

18
Q

What is used to induce remission in severe UC disease?

A

IV hydrocortisone
OR
IV ciclosporin

19
Q

What is the management of a flare up of UC?

A

IV hydrocortisone

20
Q

What is used to maintain remission in UC?

A

Aminosalicylates: Azaithoprine or Mesalazine

21
Q

What is used to assess a flare up of UC?

A

Truelove and Witts severity index

22
Q

What is classed as a severe flare up of UC?

A

More than 6 stools a day plus:
• Temperature greater than 37.8°C
• Heart rate greater than 90 beats per minute
• Anaemia (Hb less than 105g/ L)
• Erythrocyte sedimentation rate greater than 30 mm/hour

23
Q

What might you need to monitor in someone on aminosalicylates?

A

FBC- risk of agranulocytosis

24
Q

Why would you do an x-ray in someone presenting with a flare of ulcerative colitis?

A

To look for toxic megacolon

25
Q

What imaging would you consider doing in someone presenting with a flare of UC?

A

Abdominal x-ray

26
Q

What are the possible causes of a flare up of UC?

A

stress
medications (NSAIDs, antibiotics)
cessation of smoking

27
Q

What is a mild flare up of UC?

A

Fewer than four stools daily, with or without blood
No systemic disturbance
Normal ERS and CRP

28
Q

What is classed as a moderate flare up of UC?

A

Four to six stools a day
Minimal systemic disturbance

29
Q

What is used first in a mild to moderate flare of UC?

A

Topical (rectal) aminosalicylate: Azaithoprine or mesalazine

30
Q

After 4 weeks if remission is not induced, what can be added to the topical aminosalicylate?

A

Add an oral aminosalicylate

31
Q

If remission is still not induced with an topical and oral aminosalicylate what should be added?

A

Topical or oral steroid

32
Q

What can be used to maintain remission in someone with UC?

A

Topical(rectal) aminosalicylate
Add oral if that isn’t sufficient

33
Q

What can be added if a patient has had 2 or more flare ups in the last year?

A

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

Gastrointestinal (65 decks)

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