Ulcerative Colitis Flashcards

1
Q

Which areas of the gi tract does uc affect

A

Cecum to rectum • rectum is always involved (<5% case s, more commonly beds shew absence of rectal involvement

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2
Q

Age demographic affected by uc

A

2/3 onset prior to 30 with 2nd peak after 50
15% have 1st degree relative affected

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3
Q

What are the signs and symptoms of uc

A
  • Hematochezia + diarrhea (mucous)
  • tenesmus, incontinence, urgency
  • abdominal pain /cramping
  • fever, fatigue, weight loss, anorexia
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4
Q

Important questions to include in hx of uc

A

No. Of bowel movements
Triggers precipitating bm
Number of nocturnal bm
Presence of blood in no. Of bm
Severity

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5
Q

Concrbidity assoc. With uc

A

Depression and anxiety
Impaired social interactions
Impaired career progression
C. difficile infections

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6
Q

Investigations for uc

A

Definitive → Colonoscopy to distal ileum + biopsy
If exacerbation → sigmoidoscopy
Abnormal distal ileum → upper gi endoscopy
Aids → barium study. Ct abdo
Fecal calprotectin
Hb, albumin (predict severity)
ESR, CRP (predict rich of colectomy)
Serology to r/0 celiac
Steel culture + C. difficile to r/o infection
CXR + hep screen prior to starting biologies

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7
Q

Montreal classification of extent of uc

A
  • Proctitis → distal to the rectosigmoid junction, within 18 Cm of anal verge
  • left sided colitis → sigmoid to splenic flexure
  • extensive colitis → sigmoid to beyond splenic flexure
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8
Q

What are the poor prognostic factors for uc that may predict increased risk of colectomy

A
  • Age < 40 at dx
  • extensive colitis
  • severe endoscopic disease (mayo 3, uceis > or equal to 7)
  • hospitalization for colitis
    -Elevated CRP, low albumin
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9
Q

Determination of severity of uc

A

1- PRO ( bleeding + bm)
2- inflammatory burden (endoscopic assessment and markers of inflammation)
3 - disease course (hospitalization)
4- disease impact ( QOL, function)

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10
Q

When is a uc patient considered to be in remission

A

Endo mayo → 0-1
Uceis → 0-1
Stool formed
No blood
No urgency
Hb normal
ESR < 30
Crp normal
Fecal calprotectin <150 - 200

Deep remission → symptomatic remission + endoscopic healing (intact mucosa with out friability )

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11
Q

What is the criteria for classification of uc as mild

A

Endo mayo 1
Uceis 2-4
< 4 stool per day
Mild urgency
Intermittent blood in stool
Hb normal
ESR < 30
CRP elevated
Fc > 150 - 200

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12
Q

What is moderate to severe UC

A

Endo mayo 2-3
Uceis 5-8
>6 stools / day
Often urgency
Frequent blood in the stool
Hb < 75% of normal
ESR > 30
Crp elevated
Fc > 150 - 200

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13
Q

What is fulminant uc

A

Endo mayo 3
Uceis 7-8
>10 stools / day
Continuous blood in stool
Continuous urgency
Hb requiring transfusion
ESR > 30
Crp elevated
Fc > 150 - 200

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14
Q

Preventative care in uc

A

1- Vaccinations:
Flu - annual
9-26 - HPV
At risk - hep b. Hib,meningococcal
At risk and not on immune suppressants → mmrv
All adults → shingles, pneumococcal, tetanus, diphtheria, pertussis
2- osteoporosis prevention (vit d 1000 iU/d. Calcium 1200 mg/ d, exercise, no tobacco +/-bisphosphonates
3 - cancer screening → annual cervical cancer screening if on immune suppressants. Colon ca 8 yrs after dx, q1-5yrs (5 you if 2 or more normal c-scopes, 2-3 gos if mild disease and no FDR < 50
4 - monitor for Mental Health concerns

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15
Q

Rx targets for uc

A

Immediate → clinical response (50% or more decrease in Patient -reported outcome in bleeding and stool frequency)
Intermediate → normal CRP and FC
Long term → endoscopic healing , uceis 0-1

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16
Q

Pharmacotherapy for uc.

A

1- 5-ASA 1gm/d PR or 2gm/day PO → mild proctitis active or remission (PR)
mild left sided or mild extensive active or remission (PO)
moderate proctitis active or remission
2- budesonide multimatrix 9g/day po → mild proctitis, mild left sided, mild extensive, moderate active
3- prednisone→ mild proctitis, left sided, extensive, moderate, severe active
4- Anti TNF (infliximab with thiopurine, adalimumab, golimumab) → moderate and severe active or remission
5 - vedolizumab, tofacitinib → moderate, severe active if not responding to anti TNF, moderate, severe remission