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Ulcerative Colitis (Treatment (Surgery (Indicated for severe colitis that…
Ulcerative Colitis
Treatment
Mild/moderate
- Oral 5-ASA (first line for left sided/extensive)
- Rectal 5-ASA (for proctitis)
- Glucocorticoid if no response
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Thus the various aminosalicylate preparations are designed to deliver the active 5-ASA to the colon by binding to something else
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The active component of these drugs is 5-aminosalicylic acid (5-ASA) which is absorbed in the small intestine
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Epidemiology
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Highest incidence and prevalence in Northern Europe, UK and North America
An appendicectomy appears to be protective, especially if performed before 20 years.
Clinical presentation
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In acute UC there may be fever, tachycardia and tender distended abdomen
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In acute attack patients have blood diarrhoea, diarrhoea occurs at night, with urgency and incontinence that is severely disabling
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Extraintestinal signs; clubbing, aphthous oral ulcers, erythema nodusum (red round lumps below skin surface) and amyloidosis
Key facts
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Occurs when the mucosal immune system exerts an inappropriate response to luminal antigens, such as bacteria, which may enter the mucosa via a leaky epithelium
Specific
It may affect the rectum and left colon (descending colon, sigmoid colon, rectum, anus) - left sided colitis (30%)
It may affect the entire colon (large bowel) UP TO the ILEOCAECAL VALVE - pan colitis/extensive colitis (20%)
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Differential diagnosis
Alternative causes of diarrhoea should be excluded e.g. Salmonella spp, Giarda intestinal and rotavirus