Chronic Bowel Disorder - Ulcerative Colitis

Question 1

what is affected in ulcerative colitis

Answer 1

can affect region from rectum to whole colon

Question 2

common age in ulcerative colitis

Answer 2

15-25yr

Question 3

ulcerative colitis symptoms

Answer 3

• bloating
• diarrhoea
• defecation urgency
• abdominal pain

Question 4

ulcerative colitis complications

Answer 4

• colorectal cancer
• secondary osteoporosis
• VTE
• toxic megacolon

Question 5

ulcerative colitis different types (continous)

Answer 5

• proctitis
• proctosigmoiditis
• distal/left sided
• extensive colitis
• pancolitis

Question 6

tx of acute ulcerative colitis (mild-moderate)

Answer 6

• distal rectal preparation suppository or enema or
  foam preparation used if pt has difficulty retaining liquid enema
• if extended systemic medication needed
• if diarrhoea avoid loperamide or codeine as it can cause toxic megacolon
  ->only initiate under specialist advice

Question 7

proctitis tx

Answer 7

1) topical aminosalicylates (or oral if preferred less effective)
2) add oral aminosalicylates if no improvement after 4WK
3) still no improvement give topical or oral corticosteroids 4-8wk

if aminosalicylates = CI then corticosteroids for 4-8 weeks as first line

Question 8

Proctosigmoiditis and left-sided UC tx

Answer 8

1) topical aminosalicylates (can use oral but less effective)
2) add high dose oral aminosalicylates if no improv after 4wk OR
2) switch to high oral dose of aminosalicylates AND 4-8wk of of topical corticosteroids
3) STOP topical tx and offer oral aminosalicylate and 4-8wk of oral corticosteroid

If aminosalicylates = CI then topical or oral cortiocsteorids for 4-8wk

Question 9

extensive UC tx

Answer 9

1) topical aminosalicylates and high dose oral aminosalicylates
2) no change after 4wk STOP topical aminosalicylates and offer high dose oral aminosalicylates and oral corticosteroids 4-8wk

if aminosalicylates CI = oral corticosteroids 4-8wk

Question 10

life-threatening = medical emergency

UC acute (severe) tx

1st line / if CI, if sym don’t improve within 72hr

Answer 10

• IV hydrocortisone or methylprednisolone and assess need for surgery
• if IV steroids are CI use IV ciclosporsin OR surgery
• if symp don’t improve within 72hr give IV steroid + IV ciclosporin -> surgery
• if ciclosporin CI then infliximab

Question 11

UC tx maintenance

Answer 11

• oral aminosalicylates
• corticosteroids are not suitable due to s/e
• more effect as OD but more s/e

Question 12

maintenace tx of procititis or proctosigmoiditis

Answer 12

• rectal +/- oral aminosalicylates
• oral can be given if preferred

Question 13

maintenance tx of left sided/ or extensive

Answer 13

low dose oral aminosalicylate

Question 14

maintenance if 2+ flares within 12 months

Answer 14

• oral azathioprine or mercaptopurine
• monoclonal antibodies if no effect

Question 15

examples of aminosalicylates

Answer 15

sulfasalazine
balsalazine
mesalazine
olsalazine

Question 16

aminosalicylates s/e

Answer 16

• nephrotoxic
• hepatotoxic
• blood disorders
• sulfasalazine = stain contact lenses orangey/yellow

Question 17

monitoring of aminosalicylates

Answer 17

• nephrotoxicity before initation then at 3MT then annually
• hepatotoxic at monthly intervals for first 3MT
• blood disorders at monthly intervals for first 3MT
• if symptoms of blood dyscaria perform blood count and stop immediately

fatigue, weakness, abnormal bleeding or bruising, and increased susceptibility to infections