Q: 29 - 30

Q29: Rx Ulcerative Colitis

Surgical indications: Hemorrhage Toxic megacolon Acute fulminant UC (occures in 15%) Obstruction Any dysplasia Cancer Intractability Failure to thrive LONG standing disease > 10 years – proph. for

CA

Emergent / Urgent resections – Total proctocolectomy and bring up ileostomy with takedown later.

Elective: Ileoanal (Low rectal) anastomosis -- rectal

mucosectomy, J-pouch. **Infectious pouchitis – Tx Flagyl

NEED lifetime surveillance of resaidual rectum. If bad rectoanal disease – APR

Cancer risk is 1% - 2% per year starting 10 years from initial diagnosis.

Require yearly colonoscopy starting 8-10 yrs post diagnosis.

** primary sclerosing cholangitis & ankylosing spondylitis DO NOT Improve w/ resection.

Ocular problems, arthritis, anemia – Most get better w/ resection.

Pyoderma gangrenosum – upto 50% get better.

Q30: Colovesical FistulaSymptoms – fecaluria, pneumonuria.More common in Mem. Vs. colovaginal fistula.Use CYSTOSCOPY for diag.TX –

close opening in bladder Resect involved colon segment Primary colon anastemosis w/wout diverting

ileostomy.