UC

Question 1

Epidemiology of ulcerative colitis age? F:M?

Answer 1

30s

F>M

Question 2

Causes of ulcerative colitis

Answer 2

Concordance = 10%

TH2-mediated

Question 3

Protective factor against UC

Answer 3

smoking

Question 4

Macroscopic changes of ulcerative colitis

Answer 4

• Rectum + colon ± backwash ileitis ulcers,
• Contiguous
• no strictures

Question 5

Microscopic changes in ulcerative colitis

Answer 5

• Mucosal or Crypt inflammation
• shallow and broad ulcers
• marked pseudopolyps

Question 6

Symptoms of ulcerative colitis

Answer 6

• Diarrhoea
• Blood ± mucus PR
• Abdominal discomfort
• Tenesmus, faecal urgency

Question 7

Abdominal Signs of ulcerative colitis

Answer 7

• fever
• tender, bloated

Question 8

Imaging investigations for ulcerative colitis

Answer 8

AXR: megacolon (>6cm), wall thickening

Question 9

Complications of ulcerative colitis?

Answer 9

1. toxic megacolon
2. bleeding
3. malignacny (CRC or cholangiocarcinoma)

Question 10

Ba enema findings for ulcerative colitis?

Answer 10

• Lead-pipe: no haustra
• Thumbprinting: mucosal thickening
• Pseudopolyps

Question 11

Management of Severe ulcerative colitis?

Answer 11

1. NBM +fluids
2. Hydrocortisone: IV 100mg QDS + PR

Question 12

If no improvement after the initial management of severe ulcerative colitis attack, what is the treatment?

Answer 12

• On day 3, stool freq >8 or CRP >45 predicts 85% chance of colectomy
• ciclosporin, infliximab or visilizumab (anti-T cell)

Question 13

Secondary management of severe ulcerative colitis after improvement post-primary care?

Answer 13

• Switch to oral pred + a 5-ASA
• Taper pred after full remission

Question 14

Oral therapy for ulceratice colitis

Answer 14

• 1st line: 5-ASAs (eg sulfasalazine)
• 2nd line: prednisolone

Question 15

Drugs for maintaining remission in ulceratice colitis

Answer 15

1st line: 5-ASAs, sulfasalazine or mesalazine

2nd line: Azathioprine or 6-mercaptopurine

3rd line: Infliximab / adalimumab

Question 16

Indications for emergency surgery in ulceratice colitis

Answer 16

• Toxic megacolon
• Perforation
• Massive haemorrhage
• Failure to respond to medical Rx

Question 17

Emergency surgical options available to ulceratice colitis patients?

Answer 17

Total / subtotal colectomy ̄c end ileostomy ± mucus fistula+

Followed after ~3mo by either

a. Completion proctectomy + Ileal-pouch analanastomosis (IPAA) or end ileostomy
b. Ileorectal anastomosis (IRA)
c. Panproctocolectomy + permanent end ileostomy

Question 18

Elective surgery indications for ulceratice colitis?

Answer 18

• Chronic symptoms despite medical therapy
• Carcinoma or high-grade dysplasia

Question 19

Abdominal complications of surgery on ulceratice colitis?

Answer 19

• SBO- Anastomotic stricture
• Pelvic abscess

Question 20

Stoma complications of surgery on ulceratice colitis?

Answer 20

retraction,

stenosis,

prolapse,

dermatitis

Question 21

Pouch complications of surgery on ulceratice colitis?

Answer 21

• Pouchitis (50%)
• ↓ female fertility
• Faecal leakage