All of the following are true about ulcerative colitis except:: (A) Steroid dependent cases needs surgery, (B) The highest risk of UC requiring surgery in 1st year, (C) 20% end up in colectomy, (D) Extra-intestinal problems of UC are managed medically
Answer is D. Extraintestinal manifestations of ulcerative colitis: Migratory polyahritis Sacroiliitis Ankylosing spondylitis Uveitis Skin lesions Primary Sclerosing Cholangitis (PSC) Peri cholangitis Indication for Sx in UC: 1. Severe refractory fulminating disease 2. Chronic disease with a. Anaemia b. Frequent stools c. Tenesmus (cramping rectal pain) 3. Steroid-dependent disease 4. Remission cannot be maintained 5. Neoplastic change 6. Extra intestinal manifestations - PSC 7. Severe haemorrhage or stenosis causing obstruction rarely Sx of choice: 1. Subtotal colectomy & ileostomy - Emergency (20%) 2. Proctocolectomy and permanent end ileostomy 3. Proctocolectomy with ileoanal pouch. 4. Subtotal colectomy and ileorectal anastomosis