Ulcerative colitis

Question 1

What group of disorders does it come under?

Answer 1

Inflammatory bowel disease (IBD)

Question 2

What is it?

Answer 2

Mucosal inflammation and ulcers restricted to the colon and rectum

Question 3

Symptoms

Answer 3

Bloody diarrhoea (may contain mucus or pus)
Abdominal pain
Urgent need to defecate
Acute flare-up:
- Mouth ulcers
- Arthritis
- Sore skin
- Weight loss
- Fatigue

Question 4

Long-term complications

Answer 4

Colorectal cancer
Secondary osteoporosis
VTE
Toxic megacolon

Question 5

Why does secondary osteoporosis occur?

Answer 5

Long-term use of oral corticosteroids
Dietry changes

Question 6

What medications are contraindicated during an acute flare-up?

Answer 6

Loperamide
Codeine
Anti-motility/antispasmodics = paralytic ileus = increased risk of toxic megacolon

Question 7

What preparation should be used?

Answer 7

Depends on the area affected and severity

Question 8

Extensive colitis

Answer 8

Inflammation affecting most of the ascending (proximal) colon.
Includes pan-colitis (infalmmationof the total colon)

ORAL

Question 9

Left sided colitis

Answer 9

Inflammation up to descending colon (distal colon)

ENEMAS

Question 10

Proctosigmoiditis

Answer 10

Inflammation of rectum + sigmoid colon

FOAM PREPARATIONS
- foam preparations + suppositories are easier to retain than liquid enemas

Question 11

Proctitis

Answer 11

Inflammation of rectum

SUPPOSITORIES

Question 12

ACUTE
Mild-moderate UC

Answer 12

Proctitis/proctosigmoiditis:
1st line = aminosalicylate (rectal)
Alternative = rectal corticosteroid OR oral prednisolone

Extensive/left-sided colitis:
1st line = High dose oral aminosalicylate.
- If necessary add rectal aminosalicylate or oral Beclometasone
Alternative = Oral prednisolone

Question 13

SUBACUTE
Moderate-severe UC

Answer 13

1st line = oral prednisolone
Alternative = monoclonal antibodies

Question 14

ACUTE
Mild-moderate UC with treatment failure (all types)

Answer 14

1. Add oral prednisolone after 4 weeks with aminosalicylate.
2. Oral tacrolimus if not response after 2-4 weeks

Question 15

ACUTE
Severe UC (1st line)

Answer 15

Hospital admission
1st line = IV corticosteroid + assess need for surgery
Alternative = IV ciclosporin or surgery

Question 16

ACUTE
Severe UC (2nd line)

Answer 16

If symptoms don’t improve/worsen in 72 hours

IV ciclosporin + IV corticosteroids
- or surgery

Question 17

What is an alternative to ciclosporin?

Answer 17

Infliximab

Question 18

Remission

Answer 18

Aminosalicylates

Question 19

Remission - proctitis + proctosigmoiditis

Answer 19

Rectal aminosalicylate alone or with oral aminosalicylate.
- Can give oral alone if patients dont want to use enemas/suppositories BUT its not as effective

Question 20

Remission - extensive/left-sided

Answer 20

Low dose oral aminosalicylate
Single daily dose = more effective than multiple daily dose BUT associated with more side effects

Question 20

Oral azathioprine/mercaptopurine

Answer 20

Give if:
- 2+ acute flare ups in 12 months that required treatment with systemic corticosteroids.
- If remission not maintained by aminosalicylate
- After severe flare up

Question 21

Monoclonal antibodies

Answer 21

Continued if effective/tolerated during acute flare-up