UC in afya

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starts at rectum (so commonest Sx) and moves proximally but never past caecum - continuous
peaks at 15-25 or 55-65yrs

''Presentation'' - insidious and intermittent
bloody diarrhoea
urgency
tenesmus
abdo pain (LLQ)
extra-GI

''NICE 2013''
''Classify severity''
    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''
    depends on extent and severity of disease - give each step 4/52 to work before moving on
    rectal (topical) aminosalicylates (mesalazine) or steroids (for distal colitis rectal mesalazine is better )
    oral aminosalicylates
    oral prednisolone is usually used second-line for patients who fail to respond to aminosalicylates. 
    severe colitis should be treated in hospital with IV steroids 1st line

''Maintaining remission''
    oral aminosalicylates e.g. mesalazine
    azathioprine and mercaptopurine
    methotrexate is not recommended for the management of UC (in contrast to Crohn's disease)
    probiotics may prevent relapse in mild to moderate disease

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