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3 Cards in this Set
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Ulcerative colitis |
Ulcerative colitis: management
Treatment can be divided into inducing and maintaining remission. NICE updated their guidelines on the management of ulcerative colitis in 2019.
The severity of UC is usually classified as being mild, moderate or severe: mild: < 4 stools/day, only a small amount of blood moderate: 4-6 stools/day, varying amounts of blood, no systemic upset severe: >6 bloody stools per day + features of systemic upset (pyrexia, tachycardia, anaemia, raised inflammatory markers)
Inducing remission
Treating mild-to-moderate ulcerative colitis proctitis topical (rectal) aminosalicylate: for distal colitis rectal mesalazine has been shown to be superior to rectal steroids and oral aminosalicylates if remission is not achieved within 4 weeks, add an oral aminosalicylate if remission still not achieved add topical or oral corticosteroid proctosigmoiditis and left-sided ulcerative colitis topical (rectal) aminosalicylate if remission is not achieved within 4 weeks, add a high-dose oral aminosalicylate OR switch to a high-dose oral aminosalicylate and a topical corticosteroid if remission still not achieved stop topical treatments and offer an oral aminosalicylate and an oral corticosteroid extensive disease topical (rectal) aminosalicylate and a high-dose oral aminosalicylate: if remission is not achieved within 4 weeks, stop topical treatments and offer a high-dose oral aminosalicylate and an oral corticosteroid
Severe colitis should be treated in hospital intravenous steroids are usually given first-line intravenous ciclosporin may be used if steroid are contraindicated if after 72 hours there has been no improvement, consider adding intravenous ciclosporin to intravenous corticosteroids or consider surgery
Maintaining remission
Following a mild-to-moderate ulcerative colitis flare proctitis and proctosigmoiditis topical (rectal) aminosalicylate alone (daily or intermittent) or an oral aminosalicylate plus a topical (rectal) aminosalicylate (daily or intermittent) or an oral aminosalicylate by itself: this may not be effective as the other two options left-sided and extensive ulcerative colitis low maintenance dose of an oral aminosalicylate
Following a severe relapse or >=2 exacerbations in the past year oral azathioprine or oral mercaptopurine
Other points methotrexate is not recommended for the management of UC (in contrast to Crohn's disease) there is some evidence that probiotics may prevent relapse in patients with mild to moderate disease |
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Primary open angle glaucoma |
Medication Mode of action Notes Prostaglandin analogues (e.g. latanoprost) Increases uveoscleral outflow Once daily administration
Adverse effects include brown pigmentation of the iris, increased eyelash length Beta-blockers (e.g. timolol, betaxolol) Reduces aqueous production Should be avoided in asthmatics and patients with heart block Sympathomimetics (e.g. brimonidine, an alpha2-adrenoceptor agonist) Reduces aqueous production and increases outflow Avoid if taking MAOI or tricyclic antidepressants
Adverse effects include hyperaemia Carbonic anhydrase inhibitors (e.g. Dorzolamide) Reduces aqueous production Systemic absorption may cause sulphonamide-like reactions Miotics (e.g. pilocarpine, a muscarinic receptor agonist) Increases uveoscleral outflow Adverse effects included a constricted pupil, headache and blurred visio |
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Varicocele |
Varicocele
A varicocele is an abnormal enlargement of the testicular veins. They are usually asymptomatic but may be important as they are associated with infertility.
Varicoceles are much more common on the left side (> 80%). Features: classically described as a 'bag of worms' subfertility
Diagnosis ultrasound with Doppler studies
Management usually conservative occasionally surgery is required if the patient is troubled by pain. There is ongoing debate regarding the effectiveness of surgery to treat infertility |
