Brainscape's Knowledge GenomeTM

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


See full index

Gastrointestinal > Ulcerative colitis > Flashcards

Ulcerative colitis Flashcards

1
Q

What is ulcerative colitis?

A

This is an inflammatory disorder of the colon and rectum

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

Who is most at risk of ulcerative colitis?

A

Young males
Peak in 30s

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

Describe the pathophysiology of ulcerative colitis?

A

The disease starts in the rectum and moves continuously and proximally, but is confined to the colon

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

What are some symptoms of ulcerative colitis?

A

Diarrhoea
Mucus PR
Bleeding PR
Urgency
Tenesmus
Night rising
LIF pain
Proximal constipation

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

How can ulcerative colitis present on the skin?

A

Pyoderma gangrenosum
Erythema nod-sum

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

What are some extra-intestinal manifestations of ulcerative colitis?

A

Arthritis
Ankylosing spondylitis
Uveitis
Oxalate renal stones

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

What investigations are required in ulcerative colitis?

A

Bloods
Abdominal x-ray
Colonoscopy and biopsy

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

What blood test findings are expected in ulcerative colitis?

A

Raised CRP
Low albumin
Faecal calprotectin positive

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

What can be seen on AXR in ulcerative colitis?

A

Stool absent from inflamed colon
Mucosal oedema shows thumb-printing

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

What will be seen on colonscopy in ulcerative colitis?

A

Inflammation and erythema extending proximally from the anal margin
Mucosal ulceratio
Pseudo-polyps

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

Describe the histology of the colon wall in ulcerative colitis

A

Absence of goblet cells
Crypt distortion and abscesses
Mucosal layer only affected
Infiltration of monocytes/neutrophils and plasma cells

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

What is the Truelove and Witt criteria for severity of ulcerative colitis?

A

> 6 bloody stools/24 hours

As well as one of the following:
- Fever >37.8ºC
- Tachycardia >90/min
- Anaemia (Hb < 10.5 g/dL)

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

What is CLOSE UP in ulcerative colitis?

A

C - Continuous inflammation
L - Limited to colon and rectum
O - Only superficial mucosa affected
S - Smoking is protective
E - Excrete blood and mucus

U - Use aminosalycilates
P - Primary sclerosis cholangitis

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

Describe the pattern of disease in UC

A

Pattern of exacerbation and remission, with continuous, low grade activity

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

What is meant by toxic megacolon?

A

This is a single attack of ulcerative colitis, leading to complete paralysis and massive dilatation, to >6cm, which can cause rupture

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

What conditions can cause toxic megacolon?

A

Ulcerative colitis
Clostridioides difficile infection

17
Q

What are some symptoms of toxic megacolon?

A
  • Abdominal pain
  • Bloating
  • Can induce tachycardia and shock
  • Fever
18
Q

What is the treatment option for toxic megacolon?

A

Urgent decompression

19
Q

What is meant by pan-colitis?

A

Inflammation of the whole colon

20
Q

What is meant by proctitis?

A

Inflammation of the rectum

21
Q

How are flare ups of ulcerative colitis classed in terms of severity?

A

Mild - < 4 stools/day, small amount of blood

Moderate - 4-6 stools/day, varying amounts of blood, no systemic upset

Severe - >6 bloody stools per day + features of systemic upset (pyrexia, tachycardia, anaemia, raised inflammatory markers)

22
Q

What are some complications of ulcerative colitis?

A

Toxic megacolon
Increased risk of colorectal carcinoma
Blood loss - Anaemia
Hypokalaemia
Primary sclerosis cholangitis

23
Q

What are some surgical options available in ulcerative colitis?

A

Complete proctocolectomy and permanent ileostomy

Restorative proctocolectomy and J pouch

Subtotal colectomy with ileostomy

24
Q

How are mild, not hospitalised flare ups of ulcerative colitis treated?

A

1st - Rectal aminosalicylates (Oral if not cleared in 4 weeks)

2nd - Oral corticosteroids: Prednisolone, budesonide

25
Q

How are severe, hospitalised flare ups of ulcerative colitis treated?

A

1st - IV corticosteroids: Methylprednisolone, Hydrocortisone

2nd - IV cyclosporin (Immunosuppressant)

26
Q

How is remission maintained in patients with ulcerative colitis (Step-up pyramid)?

A
  1. 5-Aminosalicylate (Mebeverine)
  2. Steroids (+ Accrete D3 for bones)
  3. Azathioprine/6-Mercaptopurine
  4. Biologics
  5. Surgery
27
Q

What are some dietary treatments in structuring or fistulating Crohn’s disease?

A

Low fibre diet
Elemental diet (Modulin nutritional powder)
Struct gut rest via parenteral nutrition

28
Q

What is the pyramid of treatment in Crohn’s disease?

A
  1. Azathioprine/6-Mercaptopurine
  2. Steroids (+accrete D3 for bones)
  3. Biologics
  4. Surgery
29
Q

What dose of steroids is given in flare ups?

A

High dose for 8 weeks

30
Q

How can steroids cause weight gain?

A

They cause an increase in appetite and so food intake (Hyperphagia)

31
Q

How do 5-Aminosalicylates work?

A

They dampen down the cyclooxygenase and lipoxygenase pathways, therefore reducing formation of pro-inflammatory prostaglandins and leukotrienes

This also reduced risk of colorectal cancer

32
Q

What are some side effects of 5-Aminosalicylates?

A

Diarrhoea
Idiosyncratic nephritis (Renal function monitoring required)

33
Q

What are some examples of a 5-Aminosalicylate?

A

Sulphasalazine
Balsalazide
Mezevant
Mesalazine

34
Q

What are some examples of immunosuppressants used in UC and Crohn’s?

A

Azathioprine
6-Mercaptopurine
Methotrexate

35
Q

When would immunosuppressants be used in Crohn’s?

A

As maintenance, 1st line therapy

36
Q

When would immunosuppressants be used in ulcerative colitis?

A

As a steroid sparing agent, if the patient has received >2 courses of steroids in 12 months

37
Q

How does azathioprine (and 6-mercaptopurine) work?

A

Azathioprine is broken down into 6-mercaptopurine

6-mercaptopurine is then broken down by TMPT into Thiouric acid, 6 methyl MP and by another enzyme into 6-TGNs

6-TGNs is the active metabolite, which gets encorporated into DNA and causes bone marrow suppression

38
Q

Why are patients screened for TPMT activity before being given immunosuppression ?

A

Thiopurine methyltransferase converts 6-mercaptopurine into its inactive metabolites
If a person has an over activity of TPMT, then there could be a dangerous build up inactive metabolites

Gastrointestinal (22 decks)

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