Ulcerative Colitis Flashcards
Epidemiology of ulcerative colitis
Prevalence? age? F:M?
100-200 /100,000
30s
F>M
Causes of ulcerative colitis
Concordance = 10%
TH2-mediated
Note: Smoking protective
Macroscopic changes of ulcerative colitis
- Rectum + colon ± backwash ileitis ulcers,
- Contiguous
- no strictures
Microscopic changes in ulcerative colitis
- Mucosal or Crypt Abscesses inflammation
- shallow and broad ulcers
- marked pseudopolyps
Symptoms of ulcerative colitis
- Diarrhoea
- Blood ± mucus PR
- Abdominal discomfort
- Tenesmus, faecal urgency
Abdominal Signs of ulcerative colitis
- fever
- tender, bloated
Blood investigations for ulcerative colitis
- FBC: ↓Hb, ↑WCC
- LFT: ↓albumin
- ↑CRP/ESR
- Blood cultures
Stool investigations for ulcerative colitis
- MCS: exclude Campy, Shigella, Salmonella…
- CDT: C. diff may complicate or mimic
Imaging investigations for ulcerative colitis
- AXR: megacolon (>6cm), wall thickening
- CXR: perforation
- Ba / gastrograffin enema
- illeocolonoscopy + regional biopsy
Complications of ulcerative colitis?
- toxic megacolon
- bleeding
- malignacny (CRC or cholangiocarcinoma)
Ba enema findings for ulcerative colitis?
- Lead-pipe: no haustra
- Thumbprinting: mucosal thickening
- Pseudopolyps
Management of Severe ulcerative colitis?
- Resus: IV hydration, Nil by mouth
2. Hydrocortisone: IV 100mg QDS + PR
If no improvement after the initial management of severe ulcerative colitis attack, what is the treatment?
- On day 3, stool freq >8 or CRP >45 predicts 85% chance of colectomy
- ciclosporin, infliximab or visilizumab (anti-T cell)
- consider Surgical options
Secondary management of severe ulcerative colitis after improvement post-primary care?
- Switch to oral pred + a 5-ASA
- Taper pred after full remission
Overview of management of crohns
- Inducing remission in mild/mod disease (outpatient-based)
- Oral therapy
- topical for more left sided disease (eg suppositories)
Oral therapy for ulceratice colitis
- 1st line: 5-ASAs (eg sulfasalazine)
- 2nd line: prednisolone
Drugs for maintaining remission in ulceratice colitis
1st line: 5-ASAs PO – sulfasalazine or mesalazine (Topical Rx may be used in proctitis)
2nd line: Azathioprine or 6-mercaptopurine
3rd line: Infliximab / adalimumab
how many ulceratice colitis pts need surgery?
- 20% require surgery at some stage
- 30% ̄c colitis require surgery w/i 5yrs
Indications for emergency surgery in ulceratice colitis
- Toxic megacolon
- Perforation
- Massive haemorrhage
- Failure to respond to medical Rx
Emergency surgical options available to ulceratice colitis patients?
- Total / subtotal colectomy ̄c end ileostomy ± mucus fistula
+ 2. Followed after ~3mo by either
a. Completion proctectomy + Ileal-pouch anal
anastomosis (IPAA) or end ileostomy
b. Ileorectal anastomosis (IRA) - Panproctocolectomy + permanent end ileostomy
Elective surgery indications for ulceratice colitis?
- Chronic symptoms despite medical therapy
- Carcinoma or high-grade dysplasia
Abdominal complications of surgery on ulceratice colitis?
- SBO
- Anastomotic stricture
- Pelvic abscess
Stoma complications of surgery on ulceratice colitis?
retraction, stenosis, prolapse, dermatitis
Pouch complications of surgery on ulceratice colitis?
- Pouchitis (50%)
- ↓ female fertility
- Faecal leakage
