UC management

Question 1

UC flare classifications

Answer 1

mild
- <4 stools daily, no systemic disturbance, normal CRP

mod
- 4-6 stools, minimal systemic disturbance

severe
- >6stools, containing blood
- systemic - fever, tachycardia, abdo tenderness, anaemia
–> admit to hospital

Question 2

inducing remission in proctitis (mild-to-mod UC)

Answer 2

topical (rectal) aminosalicylate (mesalazine)

if no remission in 4weeks -> add oral aminosalicylate

still no remission -> topical/oral corticosteroid

Question 3

inducing remission in proctosigmoiditis + left sided UC

Answer 3

topical (rectal) aminosalicylate

no remission in 4 weeks –> high dose oral aminosalicylate

still no remission –> stop topical + offer oral aminosalicylate + oral corticosteroid

(mild-to-mod UC)

Question 4

management of flare UC with extensive disease

Answer 4

topical (rectal) aminosalicylate and a high-dose oral aminosalicylate

no remission in 4 weeks -> stop topical + offer high dose oral aminosalicylate + oral corticosteroid

Question 5

management of severe UC flare (systemically baaad)

Answer 5

treat in hospital
IV steroids = 1st line
-> IV ciclosporin if steroids contraindicated

no improve after 72hrs = add IV ciclosporin to IV corticosteroids or consider surgery

Question 6

maintaining remission following mild-mod UC flare for proctitis + proctosigmoiditis

Answer 6

**topical (rectal) **aminosalicylate

+/- oral too

Question 7

maintaining remission following mild-mod UC flare for left-sided + extensive UC

Answer 7

low maintenance dose of **oral **aminosalicylate

Question 8

when would oral azathioprine or mercaptopurine be used for maintiang remission in US

Answer 8

following a severe relapse

OR

> =2 exacerbations in the past yeat

Question 9

surgical management of UC

Answer 9

subtotal colectomy
- temp loop ileostomy, can be reversed later

restorative proctocolectomy
- form ileal pouch joined to anal canal, temp loop ileostomy, later reversed

complete panproctocolectomy
- removal of entire colon + rectum
- permanent ileostomy

Question 10

imaging in severe UC flare

Answer 10

abdo xray
- check for toxic megacolon

if fever and abdo pain