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Gastrointestinal > Ulcerative Colitis > Flashcards

Ulcerative Colitis Flashcards

1
Q

def

A

chronic relapsing and remitting inflammatory disease affecting large bowel

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2
Q

where in the large bowel is affected

A

colonic mucosa

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3
Q

how does inflammation occur in the large bowel

A

continuous inflammation

extends from the rectum

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4
Q

what % of UC affects just the rectum

A

50%

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5
Q

what % of UC affects the entire colon

A

20%

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6
Q

aetiology

A

unknown

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7
Q

associations

A

positive family history of IBD

PSC

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8
Q

epi

A

20-40yrs (male=female)

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9
Q

what is the relationship between smoking and UC

A

3 times more common in non-smokers

smoking may improve symptoms

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10
Q

what is the relationship between smoking and CD

A

3 times more common in smokers

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11
Q

history

A

1 bloody/mucous diarrhoea
2 tenesmus + urgency
3 crampy abdominal pain before passing stool

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12
Q

what is stool frequency related to

A

severity of disease

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13
Q

what does tenesmus and urgency indicate

A

rectal UC

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14
Q

what is used to assess the severity of UC

A

Truelove + Witts criteria

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15
Q

what are the features of the truelove + witts criteria

A 
1 motions/day
2 rectal bleeding
3 temperature
4 resting pulse
5 Hb
6 ESR/CRP
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16
Q

what features would indicate severe UC

A 
1 >6 motions/day
2 large rectal bleeding
3 >37.8 degrees
4 >90bpm
5 <105g/l
6 >30ESR, >45CRP
17
Q

examination

A

1 clubbing
2 signs of iron-deficiency anaemia (conjunctival pallor)
3 abdominal tenderness
4 blood or mucus or tenderness on DRE

18
Q

investigations

A 
1 bloods
-FBC (low Hb, high WCC)
-high ESR/CRP
2 stool
-to exclude infectious colitis
3 AXR
-to exclude toxic megacolon
4 colonoscopy + biopsy
-for disease severity, detection of dysplasia
19
Q

what is a suitable marker of disease severity

A

faecal calprotectin

released in response to inflammation in the intestines

20
Q

what organisms are excluded in stool sampling

A 
campylobacter
c. diff
salmonella
shigella
e. coli
21
Q

complications

A

1 perforation
2 bleeding
3 toxic megacolon

(colonic carcinoma, gallstones, PSC, osteoporosis)

22
Q

prognosis

A

relapsing and remitting

normal life expectancy

23
Q

what are the poor prognostic factors of UC

A 
Albumin <30g/l
Blood PR
CRP raised
Dilated loops of bowel
Eight or more bowel movements/day
Fever>38degrees
24
Q

what advice should be given to UC patients

A

1 education and support

2 regular colonoscopic surveillance (colonic cancer)

25
Q

what are the two main features of UC management

A

inducing remission

maintaining remission

26
Q

management for inducing remission in mild UC

A
  • 5-ASA3 (sulfasalazine or mesalazine) for remission induction/maintenance
  • steroids aid remission induction (prednisolone)
27
Q

management for inducing remission in moderate UC

A

IF 4-6 MOTIONS/DAY

  • 5-ASA3 (sulfasalazine or mesalazine)
  • steroids (prednisolone)
28
Q

management for inducing remission in severe UC

A

IF >6 MOTIONS/DAY

  • nil by mouth
  • IV fluids
  • IV hydrocortisone (100mg/6h)
  • rectal steroids (hydrocortisone)
  • daily monitoring of bloods, obs, examination
  • if improving switch to prenisolone + sulfasalazine to maintain remission
29
Q

what are the indications for surgery (colectomy) or rescue therapy

A

on day 3
CRP>45, or
>6 stools/day

30
Q

what is rescue therapy

A

ciclosporin or infliximab

31
Q

when is surgery indicated

A

failure of medical treatment

32
Q

management for maintaining remission

A

5-ASAs (sulfasalazine, mesalazine, olsalazine) reduce recurrence rate from 80% to 20% in 1yr

33
Q

what is the first line 5-ASA

A

sulfasalazine

34
Q

when is sulfasalazine contrindicated

A

with intolerance

in young men of whom fertility is a concern

35
Q

What are CXR findings in UC

A

Lead piping

Thumb printing

36
Q

What is riglers sign

A

Air on either side of bowl which indicates pneumoperitoneum

Gastrointestinal (62 decks)

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