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GI, liver, kidney > Ulcerative colitis > Flashcards

Ulcerative colitis Flashcards

1
Q

IN MINDMAPS FOR MEDICINE

A

yes

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2
Q

Where is UC?

A

Confined to colon- worst within rectum

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3
Q

Where is inflamamtion inv crohns?

A

Confined mycosa + submucosa

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4
Q

Histology UC

A

Crypt abscesses, mucosal ulcers and depleted goblet cells, increased inflammatory cells

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5
Q

UC x ray

A

Thumb printing
Thickening of haustral folds
Often acute inflammation

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6
Q

UC pathology

A
  • Superficial inflammation
  • Lymphoid aggregates and plasma cells
  • Bifid crypts - abscess formation
  • Crypt distance increases
  • loss absorptive surfaces
  • Psurdopolyps (non absorptive)- epithelial regenration
  • Vascular oedema and bleeding
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7
Q

UC symptoms

A
  • Cramping pain - LLQ esp
  • Blood
  • Muscous
  • Tenesmus + urgenyc
  • Classically diarrhoea (bloody)
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8
Q

What is the true love and witts severity index?

A

Rates severity og ulcerative colitis

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9
Q

What is severe UC on true love and witts severity index?

A

65+

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10
Q

What does a score of 35-64 mean on true love and witts severity index

A

moderate disease

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11
Q

What is mild disease true love and witts severity index for UC?

A

10-34

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12
Q

When is UC in remission on true love and witts severity index?

A

Under 10

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13
Q

What are the features of true love and witts severity index?

A

Bowel movements
Blood in stools
Pyrexia (37.8 degreees)
Pulse over 90BPM
Anaemia
ESR

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14
Q

Mayo endosocopic grading score 1 UC

A

Midl disease
Erythema, decreased vascular pattern, mild friability

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15
Q

Mayo UC endoscopic score 2

A

Marked erythema, absent vascular pattern, friability, erosions

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16
Q

Mayo UC endoscopic score 3

A

Severe disease
Spontaneous bleeding, ulcerations

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17
Q

Causes of UC

A
  • Infective - enteric, STIs, viral, amoebic
  • Immunological - typhilitis
  • Diverticulae
  • Microscopic
  • Medications
  • Radiation
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18
Q

Manage IBD flare

A
  • IV steriods
  • +/- ciclosporin/infliximab - immunosupression,
  • Optimise - Hb, fluids, infection, nutrition, VTE
  • Gastroenterology
  • Surgeons - colectomy
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19
Q

Severe treatment of UC

A
  • Biologicals
  • Janus kinase inhibitors
  • Infliximab/adalimubab - moncolonal TNF alpha
  • Vedolizumab
20
Q

What is proctitis?

A

Inflammation of the lining of the rectum

21
Q

Ischaemic colitis risk factors

A
  • Vasculopathies - stroke and heart attack risk also risk ischaemic bowel
  • Coagulopathic
  • Aneurysmal surgery
  • Hypotension
  • Mesenteric angina - post prandial
  • Mucosa is first thing to die - shed into stool
22
Q

Symptoms of diverticular disease

A
  • Blood
  • Constipation/haemorrhoids
  • Sigmoid involvement, normal mucose
  • Self limitng - weeks, months
23
Q

What is diverticular UC?

A

Pouches in bowel wall - heavy strain
Pockets collect faecal matter → inflamamtion and bleeding

24
Q

Causes of diverticular UC

A
  • Meds
  • Radiation
  • Microscopic
25
Q

UC on X ray

A

Thumb printing
Thickened haustral folds
Acute inflamamtion
Large bowel continious

26
Q

What meds cause UC

A

MMF - kindey or liver transplant treated, 1/3 get colitis
NSAID induced colitis
NSAID flares of IBD
Cocaine - smuggling → colitis - stimulant → vasoconstriction ⇒ ischaemic colitis

27
Q

What does radiation cause? How long before can cause?

A

3 weeks to years
- Chronic ischaemia, fibrosis, friable, enarteritis
- Bleeds, strictures

28
Q

When escalate IBD management

A

Escalate if > 2 flares a year

29
Q

What is ciclosporin

A
  • Ciclospin - clainerin inhibitor - T cell
30
Q

L sided colitis vs pancolitis

A

L sided does not expand beyond spleniic flexure, pancolitis does

31
Q

What is curatice for UC?

A

Colectomy

32
Q

Extraintestinal symptoms of UC? skin, eye, joints, bones, liver

A

Erythema nodosum, pyoderma gangronosum
Aphtlous ulcers
Episcleritis, ant uveitis
Arthritis - asymmetric, pauarticular
Sacrolitis, ank spond
Osteoporosis
Clubbibng
Primary scleroisng cholangitis

33
Q

What is mild disease parameters for each section Ture love and witts UC?

A

<4 stools a day
Small amounts bloody stool
NO anaemia, fever, normal ESR/CRP, pulse <90

34
Q

What is severe UC on true love and witts criteria?

A

> 6 stoos a day
Visible bloood in stool
At least one systemic upset 0 temp . 37.8, hr > 90, esr > 30

35
Q

Complications of UC

A

Psychological
Toxic megacolon
Colorectal cancer
VTE
Osteoporosis

36
Q

WHy do you get osteoporosis in UC?

A

Steroid use

37
Q

Ass conditions w UC

A

Turners syndorme
Wiskott Aldrich
Glycogen storage
IL-10 deficiency (refactory IBD)
Primary scleroisng cholangitis

38
Q

What is Wiskott aldrich?

A

X recessive syndrome -> imunodeficiency + thrombocytopenia

39
Q

What is Primary scleroisng cholangitis

A

Bile duct fibrosis
Autoimmune
-> encephalopathy unless liver transplant

40
Q

What gene is ass with IBD?

A

CARD 15 - crohns
2/3 - HLA B 27 - ank spond

41
Q

What bacteria increases risk of UC

A
  • Salmonella, shingella, campylobacter, Cdiff S
42
Q

1st line treatment UC

A

5 ASAs - rectal topical or steroids
eg rectal mesalazine, oral 5 ASAs

43
Q

When is oral prednisolone used in UC?

A

2nd line for patients who fail to repsond to aminosalicyclates

44
Q

Maintatining remission

A

Oral 5 ASA=s
Azathioprine/mercaptopurine
pROBIOTICS

45
Q

bARIUM enema UC what see

A

Loss of haustrations, superficial ulceration, psurdopolyps, drainpipe colon 0 narrow and short

46
Q

1st line investigation for diagnosing UC

A

Colonsocopy with biopsies

47
Q

What is lactoferrin?

A

Granulocyte iron binding glycoprotein found in stool

GI, liver, kidney (50 decks)

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