Ulcerative Colitis Flashcards
Ulcerative colitis, an idiopathic chronic inflammatory disorder, is localized to the which part of GIT….?
Colon and spares the upper gastrointestinal (GI) tract
UC which part of GIT it will start……?
Begins in the rectum and extends proximally for a variable distance.
What is proctitis and pancolitis ?..
When it is localized to the rectum, the disease is ulcerative proctitis,
whereas disease involving the entire colon is pancolitis.
Characteristics of ulcerative proctitis ….?
Ulcerative proctitis is less likely to be associated with systemic manifestations,
although it may be less responsive to treatment than more-diffuse disease.
Most common disorder in infancy misdiagnosed as Ulcerative colitis …………..?
Dietary protein intolerance
Which are the typical presentation of ulcerative colitis…….?
Blood, mucus, and pus in the stool as well as diarrhea
Define fulminant colitis. …….?
Fever, severe anemia, hypoalbuminemia, leukocytosis, and more than 5 bloody stools per day for 5 days
Chronicity is characteristically seen UC…..? Like
Weight loss
growth failure
Etiology for Iron deficiency anemia in IBD…..?
Iron deficiency can result from chronic blood loss as well as decreased intake.
Folate deficiency reason in IBD……
Folate deficiency is unusual but may be accentuated in children treated with sulfasalazine, which interferes with folate absorption.
Reason for recurrent symptoms in IBD. ?
Enteric infection
Drugs is considered by some to predispose to exacerbation. …….?
NSAIDS
It is generally believed that the risk of colon cancer begins to increase after…….. yr of disease
8-10
and can then increase by 0.5–1% per yr
DIFFERENTIAL DIAGNOSIS for UC……?
Infectious colitis, allergic colitis, and Crohn colitis
The most difficult distinction is from Crohn disease because the colitis of Crohn disease How to differentiate clinically……?
The gross appearance of the colitis or development of small bowel disease eventually leads to the correct diagnosis
When the diagnosis is suspected in a child ?…….
subacute symptoms, the physician should make a firm diagnosis only when there is evidence of chronicity on colonic biopsy
The diagnosis of ulcerative colitis must be confirmed by
endoscopic and histologic examination of the colon
Endoscopic findings in UC……..?
Classically, disease starts in the rectum with a gross appearance characterized by erythema, edema, loss of vascular pattern, granularity, and friability
There may be a cutoff demarcating the margin between inflammation and normal colon, or the entire colon may be involved
Biopsy of involved bowel demonstrates……?
Evidence of acute and chronic mucosal inflammation.
Typical histologic findings are cryptitis, crypt abscesses, separation of crypts by inflammatory cells, foci of acute inflammatory cells, edema, mucus depletion, and branching of crypts
Plain radiographs of the abdomen might demonstrate……
loss of haustral markings in an air-filled colon or marked dilation with toxic megacolon.
What is backwash ileitis….?
The colon is featureless, reduced in caliber, and shortened.
Dilation of the terminal ileum (backwash ileitis) is present
Goals of medical line of treatment….?
controlling symptoms and reducing the risk of recurrence,
With a secondary goal of minimizing steroid exposure
The first drug class to be used with mild or mild-to-moderate colitis is an……
Aminosalicylate
Sulfasalazine is composed of a………
sulfur moiety linked to the active ingredient 5-aminosalicylate (5-ASA)
This linkage prevents the premature absorption of the medication in the upper GI tract, allowing it to reach the colon, where the 2 components are separated by bacterial cleavage
Which is the major side effect of sulfasalazine ……?
Hypersensitivity to the sulfa component
occurs in 10–20% of patients
Better tolerated 5-ASA preparations ……?
mesalamine, 50-100 mg/kg/day;
balsalazide 2.25-6.75 g/day
Benefits of sulfasalazine and 5-ASA…….
Effectively treat active ulcerative colitis and prevent recurrence
Modestly decrease the lifetime risk of colon cancer.
Best therapy for UC…..?
A combination of oral and rectal 5-ASA as well as monotherapy with rectal preparation has been shown to be more effective than just oral 5-ASA for distal colitis.
Role of probiotics……? In UC
Probiotics are effective in adults for maintenance of remission for ulcerative colitis
although they do not induce remission during an active flare
The most promising role for probiotics has been to prevent pouchitis, a common complication following colectomy and ileal–pouch anal anastomosis surgery
Indication for corticosteroids in UC….?
Children with moderate to severe pancolitis or colitis that is unresponsive to 5-ASA therapy should be treated with corticosteroids
most commonly prednisone
Indication for surgical treatment in UC…?
For a hospitalized patient with persistence of symptoms despite intravenous steroid treatment for 3-5 days, escalation of therapy or surgical options should be considered.
With medical management, most children are in remission within———— months
3
Vedolizumab
A humanized monoclonal antibody that inhibits adhesion and migration of leukocytes into the GI tract, is approved for the treatment of ulcerative colitis in adults
Colectomy is performed for ??????
intractable disease,
complications of therapy, and
fulminant disease that is unresponsive to medical management
The major complication of this operation
It is a chronic inflammatory reaction in the pouch, leading to bloody diarrhea, abdominal pain, and, occasionally, low-grade fever
