Ulcerative colitis Flashcards
What group of disorders does it come under?
Inflammatory bowel disease (IBD)
What is it?
Mucosal inflammation and ulcers restricted to the colon and rectum
Symptoms
Bloody diarrhoea (may contain mucus or pus)
Abdominal pain
Urgent need to defecate
Acute flare-up:
- Mouth ulcers
- Arthritis
- Sore skin
- Weight loss
- Fatigue
Long-term complications
Colorectal cancer
Secondary osteoporosis
VTE
Toxic megacolon
Why does secondary osteoporosis occur?
Long-term use of oral corticosteroids
Dietry changes
What medications are contraindicated during an acute flare-up?
Loperamide
Codeine
Anti-motility/antispasmodics = paralytic ileus = increased risk of toxic megacolon
What preparation should be used?
Depends on the area affected and severity
Extensive colitis
Inflammation affecting most of the ascending (proximal) colon.
Includes pan-colitis (infalmmationof the total colon)
ORAL
Left sided colitis
Inflammation up to descending colon (distal colon)
ENEMAS
Proctosigmoiditis
Inflammation of rectum + sigmoid colon
FOAM PREPARATIONS
- foam preparations + suppositories are easier to retain than liquid enemas
Proctitis
Inflammation of rectum
SUPPOSITORIES
ACUTE
Mild-moderate UC
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
SUBACUTE
Moderate-severe UC
1st line = oral prednisolone
Alternative = monoclonal antibodies
ACUTE
Mild-moderate UC with treatment failure (all types)
- Add oral prednisolone after 4 weeks with aminosalicylate.
- Oral tacrolimus if not response after 2-4 weeks
ACUTE
Severe UC (1st line)
Hospital admission
1st line = IV corticosteroid + assess need for surgery
Alternative = IV ciclosporin or surgery
ACUTE
Severe UC (2nd line)
If symptoms don’t improve/worsen in 72 hours
IV ciclosporin + IV corticosteroids
- or surgery
What is an alternative to ciclosporin?
Infliximab
Remission
Aminosalicylates
Remission - proctitis + proctosigmoiditis
Rectal aminosalicylate alone or with oral aminosalicylate.
- Can give oral alone if patients dont want to use enemas/suppositories BUT its not as effective
Remission - extensive/left-sided
Low dose oral aminosalicylate
Single daily dose = more effective than multiple daily dose BUT associated with more side effects
Oral azathioprine/mercaptopurine
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
Monoclonal antibodies
Continued if effective/tolerated during acute flare-up
