Ulcerative colitis

Question 1

IN MINDMAPS FOR MEDICINE

Answer 1

yes

Question 2

Where is UC?

Answer 2

Confined to colon- worst within rectum

Question 3

Where is inflamamtion inv crohns?

Answer 3

Confined mycosa + submucosa

Question 4

Histology UC

Answer 4

Crypt abscesses, mucosal ulcers and depleted goblet cells, increased inflammatory cells

Question 5

UC x ray

Answer 5

Thumb printing
Thickening of haustral folds
Often acute inflammation

Question 6

UC pathology

Answer 6

• Superficial inflammation
• Lymphoid aggregates and plasma cells
• Bifid crypts - abscess formation
• Crypt distance increases
• loss absorptive surfaces
• Psurdopolyps (non absorptive)- epithelial regenration
• Vascular oedema and bleeding

Question 7

UC symptoms

Answer 7

• Cramping pain - LLQ esp
• Blood
• Muscous
• Tenesmus + urgenyc
• Classically diarrhoea (bloody)

Question 8

What is the true love and witts severity index?

Answer 8

Rates severity og ulcerative colitis

Question 9

What is severe UC on true love and witts severity index?

Answer 9

65+

Question 10

What does a score of 35-64 mean on true love and witts severity index

Answer 10

moderate disease

Question 11

What is mild disease true love and witts severity index for UC?

Answer 11

10-34

Question 12

When is UC in remission on true love and witts severity index?

Answer 12

Under 10

Question 13

What are the features of true love and witts severity index?

Answer 13

Bowel movements
Blood in stools
Pyrexia (37.8 degreees)
Pulse over 90BPM
Anaemia
ESR

Question 14

Mayo endosocopic grading score 1 UC

Answer 14

Midl disease
Erythema, decreased vascular pattern, mild friability

Question 15

Mayo UC endoscopic score 2

Answer 15

Marked erythema, absent vascular pattern, friability, erosions

Question 16

Mayo UC endoscopic score 3

Answer 16

Severe disease
Spontaneous bleeding, ulcerations

Question 17

Causes of UC

Answer 17

• Infective - enteric, STIs, viral, amoebic
• Immunological - typhilitis
• Diverticulae
• Microscopic
• Medications
• Radiation

Question 18

Manage IBD flare

Answer 18

• IV steriods
• +/- ciclosporin/infliximab - immunosupression,
• Optimise - Hb, fluids, infection, nutrition, VTE
• Gastroenterology
• Surgeons - colectomy

Question 19

Severe treatment of UC

Answer 19

• Biologicals
• Janus kinase inhibitors
• Infliximab/adalimubab - moncolonal TNF alpha
• Vedolizumab

Question 20

What is proctitis?

Answer 20

Inflammation of the lining of the rectum

Question 21

Ischaemic colitis risk factors

Answer 21

• Vasculopathies - stroke and heart attack risk also risk ischaemic bowel
• Coagulopathic
• Aneurysmal surgery
• Hypotension
• Mesenteric angina - post prandial
• Mucosa is first thing to die - shed into stool

Question 22

Symptoms of diverticular disease

Answer 22

• Blood
• Constipation/haemorrhoids
• Sigmoid involvement, normal mucose
• Self limitng - weeks, months

Question 23

What is diverticular UC?

Answer 23

Pouches in bowel wall - heavy strain
Pockets collect faecal matter → inflamamtion and bleeding

Question 24

Causes of diverticular UC

Answer 24

• Meds
• Radiation
• Microscopic

Question 25

UC on X ray

Answer 25

Thumb printing Thickened haustral folds Acute inflamamtion Large bowel continious

Question 26

What meds cause UC

Answer 26

MMF - kindey or liver transplant treated, 1/3 get colitis NSAID induced colitis NSAID flares of IBD Cocaine - smuggling → colitis - stimulant → vasoconstriction ⇒ ischaemic colitis

Question 27

What does radiation cause? How long before can cause?

Answer 27

3 weeks to years - Chronic ischaemia, fibrosis, friable, enarteritis - Bleeds, strictures

Question 28

When escalate IBD management

Answer 28

Escalate if > 2 flares a year

Question 29

What is ciclosporin

Answer 29

- Ciclospin - clainerin inhibitor - T cell

Question 30

L sided colitis vs pancolitis

Answer 30

L sided does not expand beyond spleniic flexure, pancolitis does

Question 31

What is curatice for UC?

Answer 31

Colectomy

Question 32

Extraintestinal symptoms of UC? skin, eye, joints, bones, liver

Answer 32

Erythema nodosum, pyoderma gangronosum Aphtlous ulcers Episcleritis, ant uveitis Arthritis - asymmetric, pauarticular Sacrolitis, ank spond Osteoporosis Clubbibng Primary scleroisng cholangitis

Question 33

What is mild disease parameters for each section Ture love and witts UC?

Answer 33

<4 stools a day Small amounts bloody stool NO anaemia, fever, normal ESR/CRP, pulse <90

Question 34

What is severe UC on true love and witts criteria?

Answer 34

>6 stoos a day Visible bloood in stool At least one systemic upset 0 temp . 37.8, hr > 90, esr > 30

Question 35

Complications of UC

Answer 35

Psychological Toxic megacolon Colorectal cancer VTE Osteoporosis

Question 36

WHy do you get osteoporosis in UC?

Answer 36

Steroid use

Question 37

Ass conditions w UC

Answer 37

Turners syndorme Wiskott Aldrich Glycogen storage IL-10 deficiency (refactory IBD) Primary scleroisng cholangitis

Question 38

What is Wiskott aldrich?

Answer 38

X recessive syndrome -> imunodeficiency + thrombocytopenia

Question 39

What is Primary scleroisng cholangitis

Answer 39

Bile duct fibrosis Autoimmune -> encephalopathy unless liver transplant

Question 40

What gene is ass with IBD?

Answer 40

CARD 15 - crohns 2/3 - HLA B 27 - ank spond

Question 41

What bacteria increases risk of UC

Answer 41

- Salmonella, shingella, campylobacter, Cdiff S

Question 42

1st line treatment UC

Answer 42

5 ASAs - rectal topical or steroids eg rectal mesalazine, oral 5 ASAs

Question 43

When is oral prednisolone used in UC?

Answer 43

2nd line for patients who fail to repsond to aminosalicyclates

Question 44

Maintatining remission

Answer 44

Oral 5 ASA=s Azathioprine/mercaptopurine pROBIOTICS

Question 45

bARIUM enema UC what see

Answer 45

Loss of haustrations, superficial ulceration, psurdopolyps, drainpipe colon 0 narrow and short

Question 46

1st line investigation for diagnosing UC

Answer 46

Colonsocopy with biopsies

Question 47

What is lactoferrin?

Answer 47

Granulocyte iron binding glycoprotein found in stool