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YR6: GASTRO > Ulcerative Collitus > Flashcards

Ulcerative Collitus Flashcards

1
Q

What is UC?

A

chronic relapsing + remitting inflammatory disease affecting the large bowel

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2
Q

How is UC disease extent divided?

A

Distal: colitis confined to rectum or rectum + sigmoid colon
Left-sided colitis: to splenic flexure
Extensive colitis: to hepatic flexure
Pancolitis: whole colon

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3
Q

Give 3 epidemiological facts about UC

A

Peak onset: 20-30s
2nd peak 50-60s
M:F
Prevalence increasing

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4
Q

Describe the aetiology of UC

A

Unknown- maybe AI condition triggered by colonic bacteria causing inflammation in GIT
Greater risk if FH present
Decreased risk in smokers

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5
Q

What is the cardinal symptom of UC?

A

Bloody diarrhoea

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6
Q

List 4 symptoms of UC

A

Colicky abdominal pain
Urgency/ Tenesmus
Weight loss
Fever

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7
Q

List 5 extra-GI manifestations of UC

A 
Uveitis
Scleritis
Erythema nodosum
Pyoderma gangrenosum
Apthous ulcers
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8
Q

What may presentation of UC mimic?

A

Amoebic colitis

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9
Q

List 8 signs of UC on examination

A 
Signs of IDA
Dehydration 
Clubbing  
Abdominal tenderness/ distension/ masses
Tachycardia  
Hypotension
Blood, mucus + tenderness on PR 
Extra-GI manifestations
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10
Q

Describe bloods taken/ results for UC

A 
FBC: Low Hb + High WCC 
High ESR/ CRP 
Low albumin 
U+Es
LFTs: detect PSC
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11
Q

Why is a stool sample used in suspected UC?

A

Infectious colitis is a ddx so stool should be tested

Allows differentiation of IBS from IBD

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12
Q

What allows for differentiation between IBS and IBD? How? Why?

A

Faecal calprotectin
Is raised in inflammatory processes (IBD)
Both IBS + IBD can present with long-term diarrhoea

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13
Q

Why perform an abdominal x-ray in suspected UC?

A

May see Lead pipe colon

To exclude toxic megacolon

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14
Q

Why perform a Flexible Sigmoidoscopy or Colonoscopy (and biopsy) in suspected UC?

A

Determines severity
Histological confirmation
Detection of dysplasia

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15
Q

What is seen on a barium enema in UC?

A

Mucosal ulceration with granular appearance + filling defects (due to pseudopolyps)
Narrowed colon
Loss of haustral pattern (“leadpipe”)

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16
Q

Which investigations may be dangerous in acute exacerbation of UC? Why?

A

Colonoscopy + barium enema

Risk of perforation

17
Q

List 6 markers of increased disease activity in UC

A 
Decreased Hb 
Decreased albumin 
Increased ESR + CRP 
Diarrhoea frequency: 
< 4 = mild, 4-6 = moderate, 6+ = severe  
Bleeding  
Fever
18
Q

Describe the management of acute exacerbations in UC

A 
IV rehydration  
IV corticosteroids  
Antibiotics  
Bowel rest  
Parenteral feeding  
DVT prophylaxis
19
Q

What is the patient likely to need if they have toxic megacolon? Why?

A

Proctocolectomy

Has high mortality

20
Q

How is mild UC managed?

A

Oral/ rectal 5-ASA derivatives (e.g. mesalazine, olsalazine, sulphasalazine)
Corticosteroids to induce remission

21
Q

How is moderate-severe UC managed?

A

Oral steroids
Oral 5-ASA
Immunosuppression (with azathioprine, cyclosporine, 6-mercaptopurine or infliximab (anti-TNF))

22
Q

What must a doctor do when managing a UC patient?

A

Educate + support patient
Treat complications
Perform colonic surveillance regularly

23
Q

When is surgery considered in treatment of UC?

A

If medical treatment fails
Presence of complications
To prevent colonic carcinoma

24
Q

What surgical procedures can treat UC?

A

Proctocolectomy with ileostomy

Ileo pouch anal anastomosis

25
Q

List 6 possible GI complications of UC

A 
Haemorrhage  
Toxic megacolon 
Perforation 
Colonic carcinoma  
Gallstones  
PSC
26
Q

List 3 possible extra-GI manifestations of UC

A

Arthropathy
Osteoporosis (from chronic steroid use)
Amyloidosis

27
Q

What is the prognosis for patients with UC?

A

Unpredictable relapses + remissions

Near normal life expectancy

28
Q

List 5 poor prognostic factors in UC

A 
Severe symptoms at presentation
Extensive disease
Raised inflammatory markers
<50 years esp. child-onset
Poor compliance with drugs
29
Q

What scoring system can be used to assess severity of UC?

A

Truelove + Witts Criteria

YR6: GASTRO (61 decks)

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