Ulcerative Colitis Flashcards
What is the pattern of disease in UC?
Relapsing-remitting
UC most commonly presents between the ages of ___________ and __________, although diagnosis can be made at any age
15
25
What is the pattern of inflammation in UC?
continuous, extending from the rectum upwards to a varying degree
Inflammation of the rectum is referred to as ______________, and inflammation of the rectum and sigmoid colon as _____________
proctitis
proctosigmoiditis
Left-sided colitis refers to disease involving the colon distal to the _______________. Extensive colitis affects the colon proximal to the ____________, and includes pan-colitis, where the ____________ colon is involved
splenic flexure
splenic flexure
whole
______________ colitis refers to disease involving the colon distal to the splenic flexure. ___________ affects the colon proximal to the splenic flexure, and includes _____________, where the whole colon is involved
Left-sided
Extensive colitis
pan-colitis
What are the common symptoms of active UC or relapse? (3)
- Bloody diarrhea
- Urgent need to defecate
- Abdominal pain
What are the complications of UC? (4)
- increased risk of CRC
- Secondary osteoporosis
- VTE
- Toxic megacolon
Management of ulcerative colitis is dependent on factors such as _______________, ______________, and _______________
clinical severity
extent of disease
patient preference
- Clinical and laboratory investigations are used to determine the extent and severity of disease and to guide treatment
Severity is classified as mild, moderate or severe by using the _________________ to assess bowel movements, heart rate, erythrocyte sedimentation rate and the presence of pyrexia, melaena or anaemia
Truelove and Witts’ Severity Index
Severity is classified as mild, moderate or severe by using the Truelove and Witts’ Severity Index to assess: … (6)
- bowel movements
- heart rate
- erythrocyte sedimentation rate
- presence of pyrexia
- melaena
- anaemia
The extent of disease should be considered when choosing the route of administration for aminosalicylates and corticosteroids; whether oral treatment, topical treatment or both are to be used. If the inflammation is _____________, a rectal preparation is adequate but if the inflammation is _____________, systemic medication is required
distal
extended
- Either suppositories or enemas can be offered, taking into account the patient’s preferences
The extent of disease should be considered when choosing the route of administration for aminosalicylates and corticosteroids; whether oral treatment, topical treatment or both are to be used. If the inflammation is distal, a(n) ______________ preparation is adequate but if the inflammation is extended, ____________ medication is required
rectal
systemic
- Either suppositories or enemas can be offered, taking into account the patient’s preferences
Rectal __________ preparations and __________ can be used when patients have difficulty retaining liquid enemas
foam
suppositories
Diarrhoea associated with ulcerative colitis is sometimes treated with anti-diarrhoeal drugs (such as ________________ or ______________) on the advice of a specialist; however their use is contraindicated in acute ulcerative colitis as they can increase the risk of toxic megacolon
loperamide hydrochloride
codeine phosphate
Diarrhoea associated with ulcerative colitis is sometimes treated with anti-diarrhoeal drugs (such as loperamide hydrochloride or codeine phosphate) on the advice of a specialist; however their use is contraindicated in acute ulcerative colitis as they can increase the risk of ________________
toxic megacolon
Diarrhoea associated with ulcerative colitis is sometimes treated with anti-diarrhoeal drugs (such as loperamide hydrochloride or codeine phosphate) on the advice of a specialist; however their use is contraindicated in __________________ as they can increase the risk of toxic megacolon
acute ulcerative colitis
Are anti-diarrheal drugs safe to use in UC?
Yes, UNLESS acute UC in which case there is a risk of toxic megacolon
A topical aminosalicylate is recommended as first-line treatment for patients with a mild-to-moderate initial presentation or inflammatory exacerbation of ____________
proctitis
A topical _______________ is recommended as first-line treatment for patients with a mild-to-moderate initial presentation or inflammatory exacerbation of proctitis
aminosalicylate
If remission of acute proctitis is not achieved within 4 weeks of treatment with topical aminosalicylates, adding a(n) _______________ should be considered. If response remains inadequate, consider addition of a topical or an oral ________________ for 4 to 8 weeks
oral aminosalicylate
corticosteroid
Monotherapy with _________________ can be considered for patients who prefer not to use enemas or suppositories, although this may not be as effective
an oral aminosalicylate
- If remission is not achieved within 4 weeks, adding a topical or an oral corticosteroid for 4 to 8 weeks should be considered
A topical or an oral corticosteroid for ____________ weeks should be considered for patients with UC in whom aminosalicylates are unsuitable
4 to 8
A(n) _________________ is recommended as first-line treatment for patients with a mild-to-moderate initial presentation or inflammatory exacerbation of proctosigmoiditis or left-sided ulcerative colitis
topical aminosalicylate
A topical aminosalicylate is recommended as first-line treatment for patients with a mild-to-moderate initial presentation or inflammatory exacerbation of proctosigmoiditis or left-sided ulcerative colitis. If remission is not achieved within 4 weeks, consider adding a(n) _______________, or switching to a(n) _______________ and 4 to 8 weeks of _______________. If response remains inadequate, stop topical treatment and offer an oral aminosalicylate and 4 to 8 weeks of an oral corticosteroid
high-dose oral aminosalicylate
high-dose oral aminosalicylate
a topical corticosteroid
A topical aminosalicylate is recommended as first-line treatment for patients with a mild-to-moderate initial presentation or inflammatory exacerbation of proctosigmoiditis or left-sided ulcerative colitis. If remission is not achieved within 4 weeks, consider adding a high-dose oral aminosalicylate, or switching to a high-dose oral aminosalicylate and 4 to 8 weeks of a topical corticosteroid. If response remains inadequate, stop topical treatment and offer _____________ and 4 to 8 weeks of _____________
an oral aminosalicylate
an oral corticosteroid
(1. Topical ASA
2. Topical ASA + oral ASA or oral ASA + topical CS)
3. Oral ASA + oral CS)
What is the first line treatment of mild-moderate extensive UC?
Topical ASA + high dose oral ASA
If remission not achieved within 4 weeks, stop topical ASA and offer high dose oral ASA + 4-8 wks of oral CS
If remission of mild-moderate extensive UC is not achieved within 4 weeks of starting topical ASA and high dose oral ASA, stop topical aminosalicylate treatment and offer _________________ and _______________.
a high-dose oral aminosalicylate
4 to 8 weeks of an oral corticosteroid
How is acute severe UC treated?
Immediate hospital admission;
*Acute severe ulcerative colitis of any extent can be life-threatening and is regarded as a medical emergency
____________________ should be given to induce remission in patients with acute severe ulcerative colitis (at first presentation or an exacerbation) while assessing the need for surgery
Intravenous corticosteroids (such as hydrocortisone or methylprednisolone)
If intravenous corticosteroids are contra-indicated, declined or cannot be tolerated, then ________________ or ______________ should be considered
intravenous ciclosporin [unlicensed indication]
surgery
A combination of ______________ with _______________, or ______________ is second line therapy for patients with acute severe UC who have little or no improvement within 72 hours of starting intravenous corticosteroids or whose symptoms worsen despite treatment
intravenous ciclosporin
intravenous corticosteroids
surgery
______________ can be used to treat acute exacerbations of severely active ulcerative colitis if ciclosporin is contra-indicated or clinically inappropriate
Infliximab
In patients who experience an initial response to steroids followed by deterioration, stool cultures should be taken to exclude the presence of pathogens; ______________ activation should be considered
cytomegalovirus
To reduce the chances of relapse occurring, maintenance therapy with ______________ is recommended in most patients with UC.
an aminosalicylate
- Corticosteroids are not suitable for maintenance treatment because of their side-effects
Are corticosteroids suitable for maintaining relapse in patients with UC?
No due to their side-effects
Maintaining remission in UC:
After a mild-to-moderate inflammatory exacerbation of proctitis or proctosigmoiditis,
______________ can be started alone or in combination with an oral aminosalicylate, administered daily or as part of an intermittent regimen (such as twice to three times weekly or the first seven days of each month)
a rectal aminosalicylate
- An oral aminosalicylate can be used alone in patients who prefer not to use enemas or suppositories, although this may not be as effective
A _______________ is given to maintain remission in patients after a mild-to-moderate inflammatory exacerbation of left-sided or extensive ulcerative colitis
low-dose of oral aminosalicylate
When used to maintain remission, single daily doses of oral aminosalicylates can be more effective than multiple daily dosing, but may result in _______________
more side-effects
Oral _________________ can be considered to maintain remission in UC, if there has been two or more inflammatory exacerbations in a 12-month period that required treatment with systemic corticosteroids, or if remission is not maintained by aminosalicylates, or following a single acute severe episode
azathioprine or mercaptopurine [unlicensed indications]
*JAK inhibitors are also used in the treatment of UC
Is MTX an effective drug in treating acute UC or maintaining remission?
No evidence to support its use in either
___________ may be necessary as emergency treatment for severe ulcerative colitis that does not respond to drug treatment
Surgery
Patients can also choose to have _______________ for unresponsive or frequently relapsing UC that is affecting their quality of life
elective surgery
Aminosalicylates (ASA) include: (4)
- Mesalazine
- Sulfasalazine
- Balsalazide
- Olsalazine
(All contain 5-aminosalicylic acid)
