Ulcerative Colitis Flashcards
def
chronic relapsing and remitting inflammatory disease affecting large bowel
where in the large bowel is affected
colonic mucosa
how does inflammation occur in the large bowel
continuous inflammation
extends from the rectum
what % of UC affects just the rectum
50%
what % of UC affects the entire colon
20%
aetiology
unknown
associations
positive family history of IBD
PSC
epi
20-40yrs (male=female)
what is the relationship between smoking and UC
3 times more common in non-smokers
smoking may improve symptoms
what is the relationship between smoking and CD
3 times more common in smokers
history
1 bloody/mucous diarrhoea
2 tenesmus + urgency
3 crampy abdominal pain before passing stool
what is stool frequency related to
severity of disease
what does tenesmus and urgency indicate
rectal UC
what is used to assess the severity of UC
Truelove + Witts criteria
what are the features of the truelove + witts criteria
1 motions/day 2 rectal bleeding 3 temperature 4 resting pulse 5 Hb 6 ESR/CRP
what features would indicate severe UC
1 >6 motions/day 2 large rectal bleeding 3 >37.8 degrees 4 >90bpm 5 <105g/l 6 >30ESR, >45CRP
examination
1 clubbing
2 signs of iron-deficiency anaemia (conjunctival pallor)
3 abdominal tenderness
4 blood or mucus or tenderness on DRE
investigations
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
what is a suitable marker of disease severity
faecal calprotectin
released in response to inflammation in the intestines
what organisms are excluded in stool sampling
campylobacter c. diff salmonella shigella e. coli
complications
1 perforation
2 bleeding
3 toxic megacolon
(colonic carcinoma, gallstones, PSC, osteoporosis)
prognosis
relapsing and remitting
normal life expectancy
what are the poor prognostic factors of UC
Albumin <30g/l Blood PR CRP raised Dilated loops of bowel Eight or more bowel movements/day Fever>38degrees
what advice should be given to UC patients
1 education and support
2 regular colonoscopic surveillance (colonic cancer)
what are the two main features of UC management
inducing remission
maintaining remission
management for inducing remission in mild UC
- 5-ASA3 (sulfasalazine or mesalazine) for remission induction/maintenance
- steroids aid remission induction (prednisolone)
management for inducing remission in moderate UC
IF 4-6 MOTIONS/DAY
- 5-ASA3 (sulfasalazine or mesalazine)
- steroids (prednisolone)
management for inducing remission in severe UC
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
what are the indications for surgery (colectomy) or rescue therapy
on day 3
CRP>45, or
>6 stools/day
what is rescue therapy
ciclosporin or infliximab
when is surgery indicated
failure of medical treatment
management for maintaining remission
5-ASAs (sulfasalazine, mesalazine, olsalazine) reduce recurrence rate from 80% to 20% in 1yr
what is the first line 5-ASA
sulfasalazine
when is sulfasalazine contrindicated
with intolerance
in young men of whom fertility is a concern
What are CXR findings in UC
Lead piping
Thumb printing
What is riglers sign
Air on either side of bowl which indicates pneumoperitoneum
