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Gen Med > Ulcerative Colitis > Flashcards

Ulcerative Colitis Flashcards

1
Q

What is UC

A

Form of inflammatory bowel disease
Age of presentation is 15-25 years and then another peak at 55-65 yrs
Follows a remitting and relapsing course

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2
Q

What is the pathophysiology of UC

A

Diffuse continual inflammation of the large bowel, beginning in the rectum and spreading proximally
A portion of the distal ileum can be affected - backwash ileitis

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3
Q

What are the histological changes in UC

A

inflammation of the mucosa and submucosa
Crypt abscesses
Goblet cell hyperplasia
Pseudopolyps - repeated cycles of ulceration and healing may lead to raised areas of inflammation

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4
Q

What are the clinical features of UC

A

Insidious in onset
Cardinal feature - bloody diarrhoea with visible blood in stool
most common manifestation is proctitis - PR bleeding with mucus, increase frequency, urgency and tenesmus
dehydration
electrolyte imbalances

Systemic features
malaise
anorexia
low grade fever

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5
Q

What is fulminant colitis

A 
severe UC 
more than 10 stools a day 
Continuous bleeding 
abdominal pain 
distension 
Systemic upset - fever and anorexia 
may be signs of peritonism
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6
Q

What is toxic megacolon

A

Acute form of colonic distension
diameter >6cm on AXR
Very dilated colon with abdominal distension, fever, shock and abdo pain
Tachycardia, low BP, high temp
Treated by decompressing the bowel or if that doesnt work a colectomy with end ileostomy
ABx given to reduce chance of sepsis ]
Corticosteroids if due to UC

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7
Q

Which classification is used to grade how severe a UC exacerbation is

A

Truelove and Witts

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8
Q

What would constitute a mild UC exacerbation

A 
<4 stools a day 
minimal blood
No pyrexia 
No anaemia 
Pulse <90
ESR <30
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9
Q

What would constitute a moderate UC exacerbation

A 
4-6 stools a day 
Mild-severe blood
No pyrexia 
pulse <90
no anaemia 
ESR 30
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10
Q

What would constitute a severe UC exacerbation

A 
>6 stools a day 
Visible blood 
Pyrexia 
Anaemia 
Pulse >90 bpm
ESR >30
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11
Q

What are the extra intestinal manifestations of UC

A

MSK: Enteropathic arthritis, clubbing
Skin: Erythema Nodosum - tender red papules on patients shins
Eyes: Episcleritis, anterior uveititis, iritis
Hepatobiliary: Primary sclerosing cholangitis - chronic inflammation and fibrosis of the bile ducts

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12
Q

What are the differentials for UC

A 
Crohns disease 
however UC patients have more bloody diarrhoea 
IBS 
Coaliac disease 
Malignancy
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13
Q

Which investigations are done in UC

A

Bedside obs
Bloods
FBC - may show anaemia and raised WCC
U+Es - may show dehydration
LFTs - may be deranged in patients on medical treatment
CRP - raised
Clotting - may be deranged in severe attacks due to large inflammatory process affecting coagulation cascade

Imaging
AXR - in acute exacerbations to determine whether toxic megacolon has occurred or perforation (erect CXR needed)
Colonoscopy with biopsy - continuous inflammation with possible ulcers and pseudopolyps (should be avoided in acute severe exacerbations)
Flexi sig may be sufficient

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14
Q

How many biopsies are needed

A

At least 2 biopsies are required from 5 sites including the rectum and terminal ileum for definitive diagnosis

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15
Q

What are the features of UC on AXR

A

Mural thickening
thumb printing
Lead pipe colon - in chronic UC best seen on barium studies

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16
Q

Which drugs should be avoided in acute attacks of UC

A

anti-motility drugs such as loperamide - can precipitate toxic megacolon

17
Q

How is remission induced in acute flares of UC

A 
A-E assessment 
Iv access 
Fluids 
Nutritional support
Prophylactic heparin 
Corticosteroids 
Immunosuppressants - azathioprine and mesalazine 
Biologics can be trialed - infliximab
18
Q

How is remission induced in mild - moderate (proctitis)

A 
Step 1: topical mesalazine or sulfasalazine 
Step 2 (if no improvement in 4 weeks): Oral prednisolone and oral tacrolimus
19
Q

How is remission induced in mild to moderate (extensive inflammation)

A

Step 1: high oral dose of mesalazine or sulfasalazine

Step 2: Oral prednisolone and Oral tacrolimus

20
Q

How is severe UC flares put into remission

A

Step 1: IV corticosteroids and assess the need for surgery

Step 2: add infliximab if no shrt term response

21
Q

How is remission maintained

A

Using immunomodulators such as mesalazine and sulfasalazine

Infliximab or othe monoclonal antibody therapy can be used as next line therapies

22
Q

What further management is offered to patients with UC

A

Due to increased risk of malignancy - colonoscopic surveillance for people who’ve had the disease for >10 yeas with >1 segment of bowel affected
IBD nurse specialists
Patient support groups
Nutritional support for young people with growth concerns
Abx only for concurrent infection or perianal disease - normally metronidazole or ciprofloxacin

23
Q

What are the indications for acute surgical treatment in UC

A

Disease refractory to medical treatment
toxic megaolon
Bowel perforation
May be undertaken to reduce risk of colonic carcinoma

24
Q

What type of surgery is offered to UC patients

A

Total proctocolectomy - curative, patient will require an ileostomy
May patients will opt for a sub total colectomy with preservation of the rectum
Some patients may undergo ileal-pouch-anal anastomosis operation, formed from loops of ileum - act as a reservoir for intestinal contents

25
Q

What re the complications of UC

A

Toxic megacolon - serious complication, dilation of the colon to at least 6cm in diameter on AXR
Colonic malignancy
Osteoporosis - should be regularly assesed for fracture risk
Pouchitis - inflammatio of the ileal pouch - abdo pain, bloody diarrhoea and nausea. Treated with metronidazole and ciprofloxacin

26
Q

What are the short term side effects of steroids

A 
Weight gain 
Increase in appetite 
Water retention 
Acne 
Thin skin that bruises easily
Mood swings and mood changes 
Reduced immune system - may get more infections
27
Q

What are the long term side effects of steroids

A 
Osteoporosis 
Thin skin 
muscle weakness 
delayed wound healing 
Cushings syndrome 
Diabetes 
High BP
Eye conditions e.g. glaucoma 
Stomach ulcers 
Mental health problems 
Addisonian crisis if steroids are stopped suddenly - suppresses HPA axis

Gen Med (10 decks)

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