Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year Two - Gastroenterology System > Ulcerative Colitis > Flashcards

Ulcerative Colitis Flashcards

1
Q

What is inflammatory bowel disease (IBD)?

A

It is defined as chronic, relapsing-remitting conditions in which there is inflammation of the gastrointestinal tract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the two inflammatory bowel disease disorders?

A

Ulcerative colitis (UC)

Crohn’s disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the most common inflammatory bowel disease - ulcerative colitis or Crohn’s disease?

A

Ulcerative colitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is ulcerative colitis?

A

It is a continuous inflammatory bowel disease that initially affects the rectum, however, never spreads beyond the ileocecal valve

Therefore, it is limited to the rectum and colon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the underlying aetiology of ulcerative colitis?

A

The underlying aetiology remains unclear

However, there is evidence that the combination of an altered intestinal microbiota and compromised colonic epithelial integrity, results in the inappropriate exposure of non-sterile intestinal contents to the underlying immunological tissue – resulting in inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the five classifications of ulcerative colitis?

A

Proctitis

Proctosigmoiditis

Left Sided Colitis

Extensive Colitis

Pancolitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is proctitis?

A

It is ulcerative colitis within the rectum only

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is proctosigmoiditis?

A

It is ulcerative colitis within the rectum and sigmoid colon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is left sided colitis?

A

It is ulcerative colitis within the rectum, sigmoid colon and descending colon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is extensive colitis?

A

It is ulcerative colitis within the rectum, sigmoid colon, descending colon and transverse colon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is pancolitis?

A

It is ulcerative colitis within the rectum and entire colon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the seven risk factors for ulcerative colitis?

A

Young Age, 15 – 30 Years Old

Middle Age, 50 – 70 Years Old

Ashkenazi Jewish Descent

IBD Family History

HLA-B27 Positive

Gastrointestinal Infection

Smoking Cessation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the five clinical features of ulcerative colitis?

A

Bloody Diarrhoea

Bowel Urgency

Tenesmus

Left Lower Quadrant Pain

Weight Loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is tenesmus?

A

It is defined as the sensation to pass stool, even though the bowel are empty

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the eight extra-intestinal manifestations of ulcerative colitis?

A

Primary Sclerosing Cholangitis

Colorectal Cancer

Arthritis

Osteoporosis

Erythema Nodosum

Pyoderma Gangrenosum

Uveitis

Episcleritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What pneumonic can be used to remember the extra-intestinal manifestations of ulcerative colitis?

A

A PIE SAC

Apththous ulcers

Pyoderma gangrenous

Iritis

Erythema nodosum

Sclerosing cholangitis

Arthritis

Clubbing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the three most common extra-intestinal manifestation of ulcerative colitis?

A

Primary Sclerosing Cholangitis

Uveitis

Colorectal Cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is pyoderma gangrenosum?

A

It is an inflammatory disorder, in which skin ulceration occurs due to dense infiltration of neutrophils in the affected tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

In which region of the body does pyoderma gangrenous occur?

A

Lower limb

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How does pyoderma gangrenous present initially?

A

A small pustule, red bump or blood blister

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How does pyoderma gangrenous present in later disease?

A

A painful ulcer, in which the edge is purple, violaceous and undermined

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What four investigations used to diagnose ulcerative colitis?

A

Blood Tests

Stool Tests

Colonoscopy + Biopsy

Abdominal X-Ray (AXR)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the five blood test results that indicate ulcerative colitis?

A

Decreased RBC Levels

Increased WCC Levels

Increased CRP Levels

Decreased Albumin Levels

Increased pANCA Levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What two stool tests are used to diagnose ulcerative colitis?

A

Faecal Calprotectin

Stool Culture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is faecal calprotectin?

A

It is an inflammatory marker, which is released during colitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What faecal calprotectin result indicates ulcerative colitis?

A

There are elevated levels of this inflammatory marker present in stool cultures – usually > 200ug/g

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

How is faecal calprotecin used to investigate ulcerative colitis?

A

This stool test is useful for distinguishing between inflammatory bowel syndrome and inflammatory bowel disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

How are stool cultures used to investigate ulcerative colitis?

A

They are used to exclude gastrointestinal infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What three gastrointestinal infections present similarly to ulcerative colitis, and are therefore important to exclude?

A

Salmonella

E.coli

Campylobacter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is the gold standard investigation used to diagnose ulcerative colitis?

A

Colonoscopy, with biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What are the five macroscopic features of ulcerative colitis on colonoscopy?

A

Continuous Uniformly Inflamed Mucosa

Erythematous Mucosa

Inflammatory Cells Infiltrate Lamina Propria Layer

No Inflammation Beyond Submucosa

Widespread Ulceration With Pseudopolyps

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What are the two microscopic features of ulcerative colitis on colonoscopy?

A

Crypt Abscesses

Decreased Goblet Cell Abundance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

In which circumstance is colonoscopy contraindicated in ulcerative colitis? Why? What is an alternative investigation?

A

In acute severe disease relapses

This is due to the increased risk of bowel perforation

Instead, a flexible sigmoidoscopy is recommended

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What are the four features of ulcerative colitis on abdominal x-ray?

A

Haustration Loss

Pseudopolyps

Toxic Megacolon

Lead Pipe Appearance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What investigation is most important to conduct during ulcerative colitis relapse? Why?

A

Abdominal X-Ray

This allows identification of toxic megacolon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What scoring system is used to classify the severity of ulcerative colitis?

A

‘Truelove & Witts’ criteria

37
Q

What is mild ulcerative colitis?

A

It is defined as the passage of < 4 stools per day with a small amount of blood present

38
Q

What is moderate ulcerative colitis?

A

It is defined as the passage of 4 – 6 stools per day with varying amounts of blood present

39
Q

What is severe ulcerative colitis?

A

It is defined as the passage of > 6 stools per day with features of systemic upset…

  • Fever > 37.8C
  • Heart Rate > 90
  • Haemoglobin < 105
  • ESR > 30
40
Q

What is the first line management option for remission induction, in mild/moderate proctitis?

A

Topical aminosalicylates (5-ASA)

41
Q

Name an aminosalicylates (5-ASA) used to manage ulcerative colitis

A

Mesalazine

42
Q

What is the second line management option for remission induction, in mild/moderate proctitis?

A

ADD Oral aminosalicylates (5-ASA)

43
Q

When is second line management option for remission induction, in mild/moderate proctitis recommended?

A

When remission is not obtained within four weeks

44
Q

What is the third line management option for remission induction, in mild/moderate proctitis?

A

Oral corticosteroids

45
Q

Name an oral corticosteroid used to manage ulcerative colitis

A

Prednisolone

46
Q

What is the first line management option for remission induction, in mild/moderare proctosigmoiditis and left sided ulcerative colitis?

A

Topical Aminosalicylate

47
Q

What is the second line management option for remission induction, in mild/moderare proctosigmoiditis and left sided ulcerative colitis?

A

ADD a high dose oral aminosalicylate

OR

Switch to a high dose-oral aminosalicylate and a topical corticosteroid

48
Q

When is the second line management option for remission induction, in mild/moderare proctosigmoiditis and left sided ulcerative colitis recommended?

A

When remission is not obtained within four weeks

49
Q

What is the third line management option for remission induction, in mild/moderare proctosigmoiditis and left sided ulcerative colitis?

A

Stop topical treatements

AND

Offer an oral aminosalicylate and an oral corticosteroid

50
Q

What is the first line management option for for remission induction, in mild/moderare extensive ulcerative colitis?

A

Topical aminosalicylate and a high dose oral aminosalicylate

51
Q

What is the second line management option for remission induction, in mild/moderare extensive ulcerative colitis?

A

Stop topical treatments

AND

Offer a high dose oral aminosalicylate and an oral corticosteroid

52
Q

What is the first line management option for remission induction, in severe ulcerative colitis?

A

IV corticosteroids

53
Q

Name an IV corticosteroid used to manage ulcerative colitis

A

Hydrocortisone

54
Q

What is the second line management option for remission induction, in severe ulcerative colitis?

A

IV DMARDs

55
Q

Name an IV DMARD used to manage ulcerative colitis

A

Ciclosporin

56
Q

When is second line management recommended in for remission induction recommended in severe ulcerative colitis?

A

If there is no improvement after 72 hours

57
Q

What are the three first line management options for remission maintenance in mild/moderate protcitis and proctosigmoiditis?

A

Topical Aminosalicylates (5-ASA)

Or

An oral aminosalicylate and a topical ainosalicylate

OR

An oral aminosalicyte

58
Q

What is the first line management options for remission maintenance in mild/moderate left sided and extensive ulcerative colitis?

A

A low maintenance dose of an oral aminosalicylate

59
Q

What is the management option for remission maintenance following a severe relapse or more than two exacerbations of ulcerative colitis in the past year?

A

Oral Thiopurine

60
Q

Name two thiopurines used to manage ulcerative colitis

A

Azathioprine

Mercaptopurine

61
Q

When are thiopurines recommended in ulcerative colitis remission maintenance?

A

Severe relapses

OR

> 2 relapses per year

62
Q

What is the third line management option for remission maintenance in ulcerative colitis?

A

Biologics

63
Q

Name three biologics used to manage ulcerative colitis

A

Infliximab

Ustekinumab

Vedolizumab

64
Q

What is the mechanism of action of infliximab?

A

Anti-TNFa

65
Q

What is the mechanism of action of ustekinumab?

A

Anti-IL-12/23

66
Q

What is the mechanism of action of vedolizumab?

A

Anti 14b7

67
Q

When are biologics recommended in ulcerative colitis remission maintenance?

A

Severe relapses

OR

> 2 relapses per year

68
Q

What is the fourth line management option for remission maintenance in ulcerative colitis?

A

Surgical management

69
Q

What are the three surgeries used to manage ulcerative colitis?

A

Subtotal Colectomy

Complete Proctocolectomy

Panproctocolectomy & Ileoanal Pouch

70
Q

When is subtotal colectomy used to manage ulcerative colitis?

A

It is recommended to manage individuals with a sudden and severe flare, in which pharmacolgoical management is deemed unsuccessful

71
Q

What is subtotal colectomy?

A

It involves resection of most of the colon, with preservation of the sigmoid colon

72
Q

Can bowel function be restored following a subtotal colectomy?

A

Yes

73
Q

How do we restore bowel function in individuals who undergo subtotal colectomy?

A

These patients undergo an ileo-anal anastomosis (J-Pouch), in which the ileum is folded back on itself and fashioned into a larger pouch that functions like a rectum

The J-Pouch is then attached to the anus to restore normal bowel function

74
Q

What is a complete protocolectomy?

A

It involves resection of the entire colon and rectum

75
Q

Can bowel function be restored following a complete protocolectomy?

A

No

These individuals don’t undergo further anastomotic surgery and thus have a permanent stoma

76
Q

What are the two forms of stomas?

A

Ileostomy

Colostomy

77
Q

What stoma is usually formed following complete protocolectomy?

A

Ileostomy

78
Q

What is the location of ileostomies? What is the appearance? Describe the output appearance

A

Right iliac fossa

Spouted

Liquid

79
Q

What is the location of colostomies? What is the appearance? Describe the output appearance

A

Varied - usually on left side of abdomen

Flushed

Solid

80
Q

When is panproctocolectomy and ileoanal pouch used to manage ulcerative coliti?

A

It is used in cases where pharmacological mamagement is unsuccessful and individuals wish to avoid a permanent stoma

However, it is only offerred in the elective setting

81
Q

What is panprotocolectomy and ileoanal pouch?

A

It involves resection of the entire colon and rectum, with formation of a temporary loop ileostomy

82
Q

Can bowel function be restored following a restorative protocolectomy?

A

Yes

83
Q

How do we restore bowel function in individuals who undergo restorative protocolectomy?

A

The loop ileostomy is later reversed with further surgery to create an ileo-anal anastomosis (J-Pouch)

84
Q

What are the five complications of ulcerative colitis?

A

Bowel Perforation

Toxic Megacolon

Malnutrition

Venous Thromboembolism

Colorectal Cancer

85
Q

What are the four clinical features associated with toxic megacolon?

A

Fever

Severe Abdominal Pain

Tachycardia

Hypertension

86
Q

What four blood test results indicate toxic megacolon?

A

Decreased Hb Levels

Increased Plt Levels

Increased WBC Levels

Increased CRP Levels

87
Q

What two features indicate toxic megacolon on abdominal x-ray?

A

Dilated transverse colon > 9cm

Thumb printing in descending colon wall

88
Q

What pneumonic can be used to remember the key features of ulcerative colitis?

A

U-C CLOSEUP

Continuous inflammation

Limited to rectum and colon

Only superficial mucosa affected

Smoking protective

Excrete blood and mucus

Use aminoglycosides

Primary sclerosing cholangitis

Year Two - Gastroenterology System (33 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions