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Ulcerative Colitis - Coggle Diagram
Ulcerative Colitis
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Management: Confirmed
Ensure the person aware that colorectal cancer screening is required and ensure this is carried out as per specialist team requirements.
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Monitoring can include serum ferritin, vitamin B12, calcium, vitamin D levels and arranging supplementation where appropriate
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Assess for clinical features suggesting a flare-up of ulcerative colitis/other symptoms and manage appropriately.
Provide information and support - lifelong condition which can be unpredictable, encourage healthy lifestyle.
Arrange referral to appropriate specialist team if required eg rheumatology, dermatology, colorectal surgeon, stoma nurse or dietician.
Assess for anxiety and depression, which may be cause my impact of symptoms on daily function
Ensure appropriate vaccinations are offered - however be aware that when taking immunosuppressive or biologic therapy then live vaccines are contraindicated.
For management of a suspected flare-up consider disease severity assessment tool and clinical judgement to see if emergency hospital admission is required. If not consider if symptoms may be due to a alternative condition and manage appropriately, check adherence to treatment and consider if specialist review is required.
Diagnosis: History
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Non-specific symptoms such as fatigue, malaise, anorexia or fever (suggestive of severe disease)
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Weight loss, faltering growth or delated puberty in children
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Family history of inflammatory bowel disease, coeliac disease or colorectal cancer
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Diagnosis: Examination
Signs of malnutrition or malabsorption - serial weight loss or in child faltering growth/delayed puberty
Eye, skin or joint signs of extra-intestinal manifestations
Abdominal distension, tenderness or mass
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Pallor, clubbing, or aphthous mouth ulcers
Management: Symptoms
Constipation - assess for bowel obstruction and if suspected arrange emergency hospital admission, if unlikely ensure diet includes adequate fluid and soluble fibre, offer information and support to help manage symptoms, if symptoms continue offer bulk-forming laxative, seek specialist advice if these measures are ineffective.
Abdominal pain - identify underlying cause if able and manage appropriately, offer analgesia for symptoms relief, consider paracetamol first line, avoid NSAIDs as they may aggravate symptoms, be aware that opiate may increase the risk of developing tox megacolon.
Diarrhoea - exclude alternative cause and manage, seek specialist advice if secondary to drug treatment, do not prescribe anti-motility drugs, offer sources of information and advice.
Fatigue - exclude alternative cause/contributing factor and manage, consider arrange blood tests (FBC, ferritine, vitamin b12, folate levels), offer sources of information and support
Oral problems - if the person develops suspected oral lesions secondary to ulcerative colitis, such as persistent aphthous ulcers, arrange referral to a specialist in oral medicine, depending on clinical judgement.
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Management: Suspected
Specialist investigation to confirm diagnosis can include colonoscopy, upper intestinal endoscopy, MRE, CT, plain abdominal x-rays and abdominal ultrasound.
Arrange referral to an appropriate specialist team if there are suspected extra-intestinal manifestations
If admission not required arrange urgent referral to gastroenterologist for specialist investigation and to confirm the diagnosis/initiate treatment
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Definition: Ulcerative colitis is a chronic, relapsing/remitting, non-infectious inflammatory disease of the GI tract. Its main characteristics are diffuse, continuous, superficial inflammation of the large bowel limited to the intestinal mucosa and usually affect the rectum with a variable length of colon involved proximally. It is classified as: ulcerative proctitis, left-sided colitis or extensive colitis.