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Flashcards in IBD - UC Deck (29)
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1
Q

Epidemiology:

A

Ulcerative Colitis > Crohn’s (1:1000 v 1:3000)

Highest prevalence in Caucasians, Jewish

2
Q

Risk Factors:

5

A
Age/Gender 
Tobacco use 
Appendectomy 
Genetics 
NSAIDS can activate
3
Q

Age/gender and IBD

A

15-40 yrs MC

Crohn’s dz is bimodal (incidence 50-70)

Female = Crohn’s,
Males = UC
4
Q

Tobacco use and UBD

A

Increased risk of crohn’s

Use of tobacco is protective against development of UC

5
Q

appendectomy and IBD risk

A

protective against development of UC

6
Q

histology of Crohn’s dx

A

skip lesions + transmural involvement

non-friable mucosa, cobblestoning

entire GI tract

thick, scarred

NON CASEATING granulomas

7
Q

histology of UC

A

superficial chronic inflammation, friable ulceration

contiguous involvement in colon

pseudopolyps and crypt abscess

8
Q

UC overview

A

chronic inflammatory condition

limited to mucosal layer of colon

more extensive disease = increased risk fo flare

9
Q

s/s UC

A

bloody diarrhea

lower abdomen cramping, fecal urgency and frequency

anemia, low albumin levels

10
Q

diagnosis UC

A

stool culture ** (to exclude infectious diarrhea)

CBC, ESR, ANCA/ASCA, Albumin

Endoscopy

11
Q

endoscopy evaluation of UC

A

location affected

appearance and biopsy for histology

12
Q

ASCA

A

antibodies that correlate Crohn’s disease

13
Q

ANCA

A

correlate with UC (cytoplasm of neutrophils)

14
Q

diagnostic test in UC

A

colonoscopy and biopsy

crypt abscess, branching, atrophy
pseudopolyps, inflammatory changes SUPERFICALLY

15
Q

UC classification based on stool frequency

A
<4 = mild 
>6 = severe
16
Q

UC acute attack tx

protitis/proctosigmoiditis

A

5-ASA suppository (Mesalamine)

IF needed PO 5ASA or corticosteroid enema

17
Q

UC acute attack tx

Mild/Mod UC

A

PO 5-ASA (Sulfasalazine)

no improvement in 5 wks = Budesonide (other corticosteroid)

If not working= immunomodulators

18
Q

when to consider total colectomy in mild mod UC flare

A

immunomodulators dont provide improvement in 72 hrs OR dilation of colon is seen on serial XR

19
Q

severe colitis tx

A

hospital admission, IVF, IV steroids, anti-TNF, surgical consult

20
Q

indications for surgical management in UC

A

severe hemorrhage, perforation, carcinoma

fulminant colitis/toxic megacolon that fails to improve in 72 hrs

relative: refractory to steroids

21
Q

surgical interventions in UC

A

colectomy + ileostomy

internal ileal pouch

total protocolectomy (can be curative)

22
Q

complications with UC surgical management

A

pouchitis

tx= probiotics and intermittent ABC

23
Q

maintenance therapy UC (steps)

A
  1. oral 5-ASA agent (Mesalamine, Sulfasalazine)
  2. immunomodulators (methotrexate)
  3. Anti-TNF inhibitors
24
Q

indication for immunomodulators UC

A

> 2 relapses/yr

corticosteroid dependent disease

25
Q

supportive UC tx

A

fiber supplements

limit gas producing veggies (beans) and caffeine

avoid antidiarrheal agents

26
Q

fulminant toxic megacolon

A

rapidly progressing UC ove r1-2 weeks with signs of toxicity

27
Q

fulminant megacolon presentation

A

fever
toxic appearing
hemorrhage = transfusion
hypovolemia

28
Q

toxic megacolon management

A

IV abx (broad spectrum)

surgical consult for colectomy

29
Q

UC prognosis

A

75-85% will relapse
20% will req. colectomy

increased risk of colon CA

increased mortality if presentation >60