Ulcerative Colitis Flashcards
Which areas of the gi tract does uc affect
Cecum to rectum • rectum is always involved (<5% case s, more commonly beds shew absence of rectal involvement
Age demographic affected by uc
2/3 onset prior to 30 with 2nd peak after 50
15% have 1st degree relative affected
What are the signs and symptoms of uc
- Hematochezia + diarrhea (mucous)
- tenesmus, incontinence, urgency
- abdominal pain /cramping
- fever, fatigue, weight loss, anorexia
Important questions to include in hx of uc
No. Of bowel movements
Triggers precipitating bm
Number of nocturnal bm
Presence of blood in no. Of bm
Severity
Concrbidity assoc. With uc
Depression and anxiety
Impaired social interactions
Impaired career progression
C. difficile infections
Investigations for uc
Definitive → Colonoscopy to distal ileum + biopsy
If exacerbation → sigmoidoscopy
Abnormal distal ileum → upper gi endoscopy
Aids → barium study. Ct abdo
Fecal calprotectin
Hb, albumin (predict severity)
ESR, CRP (predict rich of colectomy)
Serology to r/0 celiac
Steel culture + C. difficile to r/o infection
CXR + hep screen prior to starting biologies
Montreal classification of extent of uc
- Proctitis → distal to the rectosigmoid junction, within 18 Cm of anal verge
- left sided colitis → sigmoid to splenic flexure
- extensive colitis → sigmoid to beyond splenic flexure
What are the poor prognostic factors for uc that may predict increased risk of colectomy
- Age < 40 at dx
- extensive colitis
- severe endoscopic disease (mayo 3, uceis > or equal to 7)
- hospitalization for colitis
-Elevated CRP, low albumin
Determination of severity of uc
1- PRO ( bleeding + bm)
2- inflammatory burden (endoscopic assessment and markers of inflammation)
3 - disease course (hospitalization)
4- disease impact ( QOL, function)
When is a uc patient considered to be in remission
Endo mayo → 0-1
Uceis → 0-1
Stool formed
No blood
No urgency
Hb normal
ESR < 30
Crp normal
Fecal calprotectin <150 - 200
Deep remission → symptomatic remission + endoscopic healing (intact mucosa with out friability )
What is the criteria for classification of uc as mild
Endo mayo 1
Uceis 2-4
< 4 stool per day
Mild urgency
Intermittent blood in stool
Hb normal
ESR < 30
CRP elevated
Fc > 150 - 200
What is moderate to severe UC
Endo mayo 2-3
Uceis 5-8
>6 stools / day
Often urgency
Frequent blood in the stool
Hb < 75% of normal
ESR > 30
Crp elevated
Fc > 150 - 200
What is fulminant uc
Endo mayo 3
Uceis 7-8
>10 stools / day
Continuous blood in stool
Continuous urgency
Hb requiring transfusion
ESR > 30
Crp elevated
Fc > 150 - 200
Preventative care in uc
1- Vaccinations:
Flu - annual
9-26 - HPV
At risk - hep b. Hib,meningococcal
At risk and not on immune suppressants → mmrv
All adults → shingles, pneumococcal, tetanus, diphtheria, pertussis
2- osteoporosis prevention (vit d 1000 iU/d. Calcium 1200 mg/ d, exercise, no tobacco +/-bisphosphonates
3 - cancer screening → annual cervical cancer screening if on immune suppressants. Colon ca 8 yrs after dx, q1-5yrs (5 you if 2 or more normal c-scopes, 2-3 gos if mild disease and no FDR < 50
4 - monitor for Mental Health concerns
Rx targets for uc
Immediate → clinical response (50% or more decrease in Patient -reported outcome in bleeding and stool frequency)
Intermediate → normal CRP and FC
Long term → endoscopic healing , uceis 0-1
