Exam Cram

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Outline

Background 

Diagnosis

Diagnostic criteria: clinical, nil single diagnostic test

• Subjective: symptoms

• Objective: faecal calprotectin, imaging, colonic biopsy

Exacerbation severity assessment

• Stools

  • • • Mild: < 4/ d

      • Severe > 6/d

History:

Examination:

Ix

Differentials

Management

Acute

Rectal inflammation only: PR Mesalazine/ steroids

Mild exacerbation: PO mesalazine

Severe exacerbation: 

1. Prednisolone

2. Ciclosporin

3. Infliximab

4. Subtotal colectomy & ileostomy

Chronic Mx

PR > PO if rectal disease only

1. Mesalazine

2. Azathiopine

Indications for subtotal colectomy & ileostomy

• Colon > 6cm  (British society of gastroenterology)

• Not responded to 7d of rescue therapy (infliximab/ ciclosporin)

• Complications: toxic megacolon, perforation

• Bowels > 9/d predicts 80% treatment failure

Deeper Dive

Diagnosis

There is no single diagnostic test for ulcerative colitis. Symptoms are suggestive (persistent diarrhoea). CT imaging shows non specific colitis and biopsy of the colon shows non specific colonic inflammation. Core differentials are required to be excluded such as a infective or ischaemic colitis. 

References

1. https://cks.nice.org.uk/topics/ulcerative-colitis/diagnosis/diagnosis/

Page written in 2024. 

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