Ulcerative Colitis

Question 1

What is ulcerative colitis

Answer 1

Relapsing remitting inflammatory disorder of the colonic mucosa
Continuous inflammation
Colon only - maybe backwash ileitis
Only mucosa - may affect lamina propria with punctuate lesions

Question 2

When it only effects the rectum

Answer 2

Proctitis

30% of people

Question 3

When it extends to the left sided colon

Answer 3

Left sided colitis

40%

Question 4

when it effects the entire colon

Answer 4

Pancolitis 30%

Question 5

Symptoms

Answer 5

Chronic/episodic diarrhoea 
\+- mucous blood 
Crappy abdominal discomfort 
More bowel motions inc severity of episodes 
In attacks = systemic symptoms 
Fever, Malaise, dec weight, anorexia

Question 6

Signs

Answer 6

May be none
Acute severe: fever, tachycardia, tender distended abdomen
Extra intestinal features: clubbing, aphthous oral ulcers, erythema nodesum, pyoderma gangrenosum, uveitis, conjunctivitis, episcleritis, large joint arthritis, ank spondylitis, nutritional defects

Question 7

Tests

Answer 7

FBC, U&E, CRP/ESR, LFT, blood culture
Looking for infection, kidney injury, liver injury

Stool MC&S/CDT
fecal calprotectin inflamm in gut
AXR no fecal shadows, mucosal thickening islands, colonic dilation

Lower GI endoscopy in an attack sigmoid and take biopsy when better colonoscopy assessing scope of disease

Question 8

Complications

Answer 8

Acute 
Toxic dilation of colon >6cm 
Risk perforation 
VTE
Chronic 
Inc cancer of colon 
Can affect mucosa that looks apparently normal 
So surveillance is needed, 1-3years + Random biopsies

Question 9

Treatment aim

Answer 9

Induce remission

Maintain remission

Question 10

Treatment depends on the what

Answer 10

Severity of the disease

Question 11

What criteria can assess the severity Of the disease

Answer 11

True love & witts criteria

Question 12

What is the mild criteria symptoms

Answer 12

4 or less motion a day
Small rectal bleeding 
Apyrexial
BP<70 
Hb >110
CRP <30

Question 13

What is the moderate symptoms criteria

Answer 13

5 motion a day 
Moderate bleeding 
Temp 37.1-37.8
HR 70-90
Hb 105-110

Question 14

Severe symptoms criteria

Answer 14

Same or more than 6 motions a day 
Temp above 37.8
Rectal bleeding severe
HR>90
Hb 105-110
CRP >30

Question 15

Mild UC treatment

Answer 15

5ASA mesalazine
Proctitis PR
Extensive PO
PR topical steroid foam

Question 16

Moderate treatment

Answer 16

Oral prednisone

Maintain with 5ASA

Question 17

Severe treatment

Answer 17

IV hydration and electrolyte replacement
IV steroids 
PR VTE
imp to keep monitoring, and examining 
If responding to steroids change to PO
If not responding need rescue therapy with inflixinab or cyclosporine 
Day 3-5 rescue meds
Day 7-10 surgery

Question 18

What maintainers therapy is needed when infliximab is given as a rescue

Answer 18

Infliximab

Question 19

What maintainers therapy is needed when cyclosporine is given as a rescue

Answer 19

Azathioprine