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F1 Gen Surg > Ulcerative colitis > Flashcards

Ulcerative colitis Flashcards

1
Q

What is ulcerative colitis (UC)?

A

Ulcerative colitis (UC) is a chronic inflammatory condition characterized by a relapsing and remitting course and continuous mucosal inflammation of the colon without granulomas on biopsy.

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2
Q

What areas of the body does UC affect?

A

UC affects the rectum and a variable extent of the colon.

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3
Q

At what age do patients usually present with UC?

A

Patients usually present with UC in late adolescence or early adulthood, but it can occur at any age.

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4
Q

Does UC affect both sexes equally?

A

Yes, UC affects both sexes equally.

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5
Q

How is distribution of disease in UC described as?

A

The distribution of disease is described by the maximal macroscopic extent of inflammation noted at colonoscopy.
The Montreal classification is commonly used to define the distribution of disease (Fig 1)

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6
Q

How is disease activity in UC determined?

A
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7
Q

How is UC diagnosed?

A

Diagnose UC through a combination of:

Medical history, plus
Clinical assessment, plus
Endoscopic (Fig 1) and histological findings

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8
Q

DDX for UC

A

Differential diagnoses

Crohn’s colitis
Infective aetiologies
Diverticulitis
Colorectal malignancy
Microscopic colitis
Ischaemic colitis
NSAID-induced colitis

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9
Q

Which medication can potentially exacerbate UC?

A

NSAIDs

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10
Q

How can differentiate between diarrhea caused by infectious etiologies and UC?

A

The occurrence of loose stools for more than 6 weeks differentiates UC from the majority of infectious aetiologies.

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11
Q

How do patients with proctitis usually present?

A

Patients with proctitis usually present with rectal bleeding, urgency and tenesmus

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12
Q

How do patients with more extensive UC usually present?

A

Patients with more extensive disease present with loose stool usually associated with rectal bleeding. They may also describe:

Tenesmus
Faecal urgency
Nocturnal defaecation
Mucous discharge
Abdominal pain relieved by defaecation

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13
Q

What does left sided colitis refer to?

A

Left-sided colitis refers to inflammation distal (below) the splenic flexure.

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14
Q

True or false
UC is characterised by a relapsing and remitting course

A

True.

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15
Q

True or false
A history of nocturnal defaecation is more suggestive of UC than IBS

A

True

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16
Q

Prefered investigation for diagnosing UC

A

Colonoscopy is the preferred test for diagnosing and determining the extent of disease.
However, it should be avoided in severe disease, where an unprepared sigmoidoscopy can be performed if required

17
Q

Investigations in UC and why

A
  • Basic blood tests
  • Stool tests (to exclude infectious etiology)
  • Fecal calprotection (It can be useful to distinguish young patients with diarrhoea-predominant IBS.)
  • Radiological investigations (X-Ray, CT with contrast if unsure of diagnosis)
  • Colonoscopy
18
Q

What is fecal calprotectin

A

This is a marker of colonic inflammation

19
Q

Medical therapies for UC

A

The optimal treatment strategy varies with the extent of inflammation and can include oral and/or topical therapies and includes:
- 5-ASA drugs (mesalazine)
- Corticosteroids (Sometimes used in active disease, not for maintenance)
- Thiopurines (azathioprine or 6-mercaptopurine)

Rescue therapy include ciclosporin and biologics

20
Q

Indication of thiopurines

A

Indications:

  • Steroid sparing agents in patients with steroid refractory disease or those - requiring frequent courses of treatment
    Patients intolerant of, or failing to respond to, treatment with 5-ASAs
21
Q

Medical treatment of proctitis

A

First line treatment is a topical 5-ASA, administered as a suppository and/or enema.
Topical 5-ASAs are more effective than topical steroids, although they can be used in combination.

22
Q

Medical treatment of left sided UC

A

This is most effectively treated with a combination of an oral and topical 5-ASA.
Oral or topical 5-ASA monotherapy or topical steroids are less effective than this combination.
Oral corticosteroids can be added if there is a lack of response to the above treatment.

23
Q

Medical treatment of extensive colitis

A

Initial treatment should comprise an oral 5-ASA. However, addition of a topical 5-ASA can be added if tolerated.
Add oral corticosteroids if there is a lack of response to the above treatment.
Consider escalation of medical therapy to include immunosuppressants if patients have a poor response or frequent disease relapses despite the treatments outlined above.
Admit any patient with severe colitis to hospital for further assessment and treatment.

24
Q

CRP and ESR in UC

A

markers of disease activity (except in ulcerative proctitis where they can often be normal)

25
Q

True or false
Albumin is used to assess a patient’s nutritional status in UC

A

False, Albumin is a poor marker of a patient’s nutritional status but provides valuable information regarding disease severity

26
Q

True or false
Mucosal islands identified on an abdominal x-ray are a good prognostic marker in UC

A

False, Mucosal islands are a poor prognostic marker and predict a high probability that surgical intervention will be required.

27
Q

True or false
Sigmoidoscopy is the preferred investigation to assess disease activity in patients presenting with features of severe colitis

A

True

28
Q

True or false
Inflammatory markers can be normal in patients with limited disease extent

A

True

29
Q

Treatment of UC, aside from medical drugs

A
30
Q

True or false
Avoid low molecular weight heparin due to the increased risk of rectal bleeding in UC

A

False, Heparin should be prescribed routinely, due to the increased risk of thromboembolic events in patients with active disease. It should only be avoided in patients with severe rectal bleeding.

31
Q

True or false
Infliximab is the first line rescue therapy in patients with severe colitis failing to respond to steroid therapy in UC

A

False. NICE guidelines recommend that infliximab only be used in cases where ciclosporin is contraindicated or inappropriate for use.

32
Q

True or false
Discontinue anti-diarrhoeal agents in patients with severe colitis in UC

A

True

33
Q

What happens to patients not responding to medical therapy in UC?

A
  • Discuss surgery in patients who fail to respond to medical therapy or those who develop complications such as toxic megacolon.
  • Staged surgery is recommended, with a sub-total colectomy being the operation of choice. Patients are provided with an end ileostomy and rectal stump, allowing reversal at a later stage.
34
Q

When is surgery indicated in UC?

A

Elective surgery for UC is indicated for:

Ongoing symptoms or frequent relapses despite optimal medical therapy
The presence of colonic high grade dysplasia or adenocarcinoma

35
Q

What are the main complications of acute colitis?

A
  • Toxic megacolon (Can result in colonic perforation)
  • Large volume rectal bleeding
  • Thromboembolism
  • Colorectal malignancy

F1 Gen Surg (19 decks)

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