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Flashcards in FN: Ulcerative collitis management Deck (21):
1

Investigations

Bloods
Stool
Imaging

2

Blods shows

1. Reduced Hb, raised WCC
2. LFT: reduced albumin
3. CRP/ESR raised
4. Blood cultures

3

Stool

MCS: exclude campy, shigella, salmonella
CDT: C.diff may complicate or mimic

4

Imaging

1. AXR: megacolon (>6cm), wall thickening
2. CXR: perforation
3. CT
4. Ba/gastrogaffin enema
Ileocolonoscopy + regional biopsy: Baron score

5

Severity score

Truelove and witts criteria
Motions
PR bleed
Temp
HR
Hb
ESR

6

Motions

Severe >6
Mild

7

Acuter Severe UC management

1. REsus: admit, IV hydration, NBM
2. hydrocortisone: IV 100mg QDS + PR
3. Transfuse if required
4. Thromboprohpylaxis: LMWH

8

Acute complcations

Perforation
Bleeding
Toxic megacolon (>6cm)
VTE

9

Improvement --> orl therapy

Switch to oral perd and 5-ASA
taper pred after full remission

10

Non improvement on oral therapy

1. On day 3: stool freqeuncy >8 or CRP >45 - predicts 85% chance of needing a colectomy during the admission
2. Discussion between pt. physcian and surgeon
3. Medical: ciclosporin, infliximab or visilzumab (anti-t cell)
Surgical

11

ORal therapy

5-ASA
prednisolone

12

Topical therapy

Mainly left sided disease
Practitis: suppositiries

13

Additional therapy

Steroid sparing
Azathiorpine or mercaptopurine
Infliximab: steroid - dependent ps

14

1st line

5-ASAsPO - sulfasalazine or mesalazine: topical Rx may be used in proctitis

15

2nd line

Azathioprine or mercaptopurine
1. relapsed on ASA or are steroid-dependent
2. Give 6-mercaptoprurine if azathioprine intolerant

16

3rd line

Infliximab/adalimumab

17

Indication sofr surgery

Toxic megacolon
Perforation
MAssive haemorrhage
Failure to respond to medical Rx

18

Surgical complications

Abdominal
SBO
Anastomotic stricture
Pelvic abcess
Stoma: retraction, stenosis, prolapse, dermatitis
Pouch:
Pouchitis (50%): metronidazolw + cipro
Reduced female fertility
Faecal leakage

19

Surgical complications

Abdominal
SBO
Anastomotic stricture
Pelvic abcess
Stoma: retraction, stenosis, prolapse, dermatitis
Pouch:
Pouchitis (50%): metronidazolw + cipro
Reduced female fertility
Faecal leakage

20

Elective surgery indications

1. Chronic symptoms despite medical therapy
2. Carcinoma or high-grade dysplasia

21

Procedures

Panproctocolectomy with end ileostomy or IPAA
Total colectomy with IRA

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