Term
| pathologically, what's happening in UC |
|
Definition
| recurring episodes of inflammation limited to the mucosal layer, usually rectum upwards |
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Term
| how does UC usually present |
|
Definition
| episodes of colitis with small frequent often bloody bms, fever, fatigue, wt loss. almost always anemic |
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Term
|
Definition
usually normal physical exam
unless severe: mm wasting, anorexia, wt loss, pallor from anemia, edema from malnutrition etc |
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Term
|
Definition
| < 4bm a day, normal ESR, mild abdo pain |
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|
Term
| how is MODERATE UC defined |
|
Definition
| >4 bm a day, blood in stool, anemia but not requiring transfusions |
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Term
|
Definition
| 6+ bm a day, blood in stool, anemia, may require transfusion, ESR > 30, severe pain, tachypnea |
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|
Term
| What is Fulminant colitis |
|
Definition
over 10 bm a day
continous bleeding
serious pain, distention
toxic symptoms |
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Term
|
Definition
| colon diameter 6+ cm or cecum 9+ cm with toxic symptoms |
|
|
Term
| what is the biggest risk of toxic megacolon |
|
Definition
|
|
Term
| what is the mortality of perfortation |
|
Definition
| 50% if they get peritonitis |
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Term
|
Definition
1. peripheral arthritis of large joints
2. ankylosing spondylitis
3. osteoporosis, osteopenia, osteonecrosis |
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|
Term
|
Definition
|
|
Term
| what are hepatobilary sx of UC |
|
Definition
1. primary sclerosing cholangitis
2. fatty liver
3. autoimmune liver |
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|
Term
| what are the major features of PSC |
|
Definition
| hi AP, fatigue, pruritis, fever, chill, night sweats |
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|
Term
| skin manifestations of UC |
|
Definition
pyoderma necrosis
erythema nodosum |
|
|
Term
|
Definition
| inflammation of fat cell s on anterior shin that makes large firm painful nodules |
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|
Term
| what are the heme manifestations of UC |
|
Definition
increased risk of VTE
AIHA
ACD
IDA |
|
|
Term
| What are the pulmonary manifestations of UC |
|
Definition
parncymal lung disases, bronchiectasis, airway inflammation
(all very rare) |
|
|
Term
| What immuno labs may be positive in a pt with UC |
|
Definition
|
|
Term
| Electrolyte abnormalities in UC |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| only elevated AP if they have PSC |
|
|
Term
| What are the endoscropy findings in UC |
|
Definition
| erythematous, friable, ulcerations, petechia, polyps |
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|
Term
|
Definition
abscess
crypt branching
crypt shortening
crypt atrophy |
|
|
Term
|
Definition
chronic diarrhea for more than 4 weeks and chronic colitis on endosccopy and biopsy
+
eclusion of all other diagnosis |
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|
Term
| things that can mimic ulcerative colitis |
|
Definition
CMV in immunocompromised pts
infectious colitis
chrons
radiation colitis
solitary rectal ulcer syndrome
diverticulitis |
|
|
Term
| what does solitary rectal ulcer syndrom look like on biopsy |
|
Definition
| thickened mucosa, not inflammed like in UC |
|
|
Term
| what % of pts will require colectomy |
|
Definition
|
|
Term
| what does age of onset have to do with severity of disease? |
|
Definition
| onset later in life has better prognosis |
|
|
Term
|
Definition
| showed that early ulcer mucosal healing with inflixamib use had a lower risk of colectomy. |
|
|
Term
| chronic gi complications of UC |
|
Definition
strictures
dysplasia and CA |
|
|
Term
| when is mortality highest in pts with UC |
|
Definition
| in 1st year after diagnosis |
|
|
Term
| How do you treat a pt with first episode of mild protatis or sigmoidproctatis |
|
Definition
|
|
Term
| how effective id topical rectal 5ASA in pt with mild first episode? |
|
Definition
|
|
Term
| in what forms can you give 5ASA |
|
Definition
| foam, gel, suppository, enema |
|
|
Term
| when do you use a supposity of 5ASA as opposed to an enema or oral |
|
Definition
| when inflammation is within 5-8 cm of rectum |
|
|
Term
| how often do you dose supposity of 5ASA |
|
Definition
|
|
Term
| when do you give oral 5ASA |
|
Definition
| only when they cant tolerate topical. it dosent work as well |
|
|
Term
| when do you give topical steroids |
|
Definition
| only when they cant tolerate any type of 5ASA |
|
|
Term
| When do you do maintenance therapy |
|
Definition
| if proctatis episode > 1 yr or they have any episodes that extend to sigmoid |
|
|
Term
| what do you give for maintenance therpay in mild mod disease |
|
Definition
| 5ASA supposityry q nightly OR oral 5ASA if cannot tolerate suppository. |
|
|
Term
| what do you NOT give in maintenance therapy in mild mod disease |
|
Definition
|
|
Term
| what do you do for maintenance therapy in a pt with mild mod disease that extends past sigmoid? like left sided colitis or pancolitis |
|
Definition
| may use combo supposity and oral |
|
|
Term
| 5asa vs mesalamine vs balsalzide |
|
Definition
5ASA is the same as mesalamine
balsalzide is similar but may be better at inducing remission during an acute episode |
|
|
Term
|
Definition
1gBID if supposity
4g if enema |
|
|
Term
|
Definition
2.4-4.8 for acute
1.6-2.4 for maintenance |
|
|
Term
| initial therapy in severe UC |
|
Definition
| IV steroid, oral 5ASA, suppository, cipro and metronidazole if signs of toxicity |
|
|
Term
| what meds do you dc in a pt with severe UC? why? |
|
Definition
| anticholinergics, NSAIDS, opioid, antidiarrheals. they can precipitate toxic megacolon |
|
|
Term
| how do you do maintenance of severe UC? |
|
Definition
| taper oral steroids once stable for 4 weeks. keep oral 5ASA. |
|
|
Term
|
Definition
-when you cant have steroid tx dip below 10mg for 3 mo
-give 6mercaptopurine/AZA for slow acting treatment
-can add cyclosporine, infliximab, adalimab for fast acting |
|
|
Term
|
Definition
no response to glucocoritcoids for 30day
-cyclosporine and inflixamab |
|
|
Term
| how do you manage diarrheal sx in UC |
|
Definition
| can give loperamide but it increases the risk of toxic megacolon, so never give if there is risk of toxicity |
|
|
Term
| what drugs are contraindicated in UC |
|
Definition
| opiates. can precipitate toxic megacolon |
|
|
Term
| cancer screening in UC pts |
|
Definition
surveillance after 8 years post-dx of pancolitis
surveillance after 15 yrs of diagnosis if L sided colitis
rpt every 1-2 years |
|
|
Term
| what drug may decrease the risk of cancer in UC pts? |
|
Definition
|
|
Term
|
Definition
| pts with UC are more likely to have abnormal pap smears and not follow up from them |
|
|
Term
|
Definition
| increased incidence of skin cancer in pts with UC on 6MP or AZA |
|
|
Term
|
Definition
UC confined to colon, does not usually have perianal involvement, usually continuous
chrons is discontinous, in large and small intestine, often with perianal involvement |
|
|
Term
|
Definition
| often fistulas in chrons, never in UC |
|
|
Term
| depth of inflammation in UC vs chrons |
|
Definition
confined to mucosa in UC
transmural fissures in chrons |
|
|
Term
|
Definition
helps with UC
worsens with chrons |
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