Transcription - 20250530T 12-23.mp3

So next patient is diane froed alpha 4 0 9 6 1 0 diagnosis left sided ulcerative colitis diagnosed in june 2022 requiring steroids at diagnosis investigations most recent colonoscopy 20 22 moderate mucosal erythema and friability, contact bleeding, loss of vascular pattern and erosions from insertion to the proximal descending: the rest of the colonic mucosa and ileum look normal with a very small patch of inflammation the cecum moderate distal ulcerative colitis mayo score 2 histology terminal ileal biopsies small intestinal casing normal villous architecture no increase in lymphocytes active inflammation or granulomatous normal histological limits colonic biopsy series mild to moderate active chronic inflammation crypt abscesses in more inflamed areas in keeping with active chronic inflammatory bowel disease most recent bloods 20 22 demonstrating high platelets and anemia find deficient hi is that diane fried hi I'm doctor rob miller I'm 1 of the gastroenterology registrars here at dareford how are you yep I'm glad now number 1 flexible sigmoidoscopy 2 week wait number 2 course of steroids number 3 pre immunologic screening and blood tests for flare number 4 consideration of systemic treatment with results of premium logic screen, flexible sigmoidoscopy blood tests number 5 trial of suppositories I had the pleasure of speaking on the telephone to missus faree today on behalf of doctor hayward in bowel disease clinic full stop <\n\n> She was diagnosed with left sided ulcerative colitis in june 2022 full stop she required steroids at her initial diagnosis and subsequently started on octavia 2.4 g full stop unfortunately, she found the octavia gave her diarrhea which I explained can sometimes happen with this medicine and so she was not able to take it and stopped it full stop <\n\n> Since then, she's had good and bad days with occasional stomach cramps and occasional loose stools however something that she finds tolerable full stop <\n\n> Unfortunately, over the last 4 to 6 weeks she's been having significant urgency after eating passing a watery type 7 stool with occasional visible blood 6 times a day full stop she hasn't had any fevers but she is feeling tired and lethargic alongside it full stop <\n\n> She's noticed that she's lost some weight over the last few months her clothes are looser or that she doesn't weigh herself and she's avoiding food because she lacks an appetite and also because she's trying to improve her symptoms by restricting full stop <\n\n> In terms of her life more generally, she has 3 young boys and works a desk job from home most of the time however is is required to go into the office occasionally which she understandably finds difficult giving her bowel habit full stop <\n\n> She doesn't smoke and doesn't drink alcohol excessively full stop <\n\n> We discussed today that it's likely that she's had ongoing bowel inflammation for some time and it doesn't sound like we've ever got complete control of it apart from when we gave her steroids full stop <\n\n> I explained that in order we want to control her symptoms in order to allow her to live a full life but we also wanna decrease bowel inflammation in order to decrease her risk of developing malignancy in the future full stop <\n\n> Without any blood tests she's a moderate on the true love and wits criteria for flare of ulcerative colitis and so I'll send her out some suppositories 5 asa suppositories which I've hope will will help her left sided proctitis symptoms as well as a course of steroids to dampen down any underlying inflammation full stop I'll request an urgent flexible sigmoidoscopy for her to assess her disease activity as well as some blood tests and with these things we can establish whether escalation of treatment and consideration of thiopurines would be sensible for her given her intolerance to 5 asa to 5 asa therapy full stop <\n\n> I look forward to discussing with her again in 6 weeks time with the results of investigations full stop in the plan blood tests should be crp euthanese lfts full blood count and free immunologic screening

Diagnosis:
Left-sided ulcerative colitis diagnosed 2022

Other Medical Diagnoses
None mentioned

Medications:
**5-ASA suppositories (newly started)**
**Clipper course 5mg OD for 43 weeks. (newly started)**

Investigations:
Colonoscopy June 2022: Moderate mucosal erythema and friability, contact bleeding, loss of vascular pattern and erosions from insertion to the proximal descending colon. The rest of the colonic mucosa and ileum look normal with a very small patch of inflammation in the caecum. Moderate distal ulcerative colitis Mayo score 2.
Histology 2022: Terminal ileal biopsies - small intestinal mucosa with normal villous architecture, no increase in lymphocytes, active inflammation or granulomas within normal histological limits. Colonic biopsy series - mild to moderate active chronic inflammation with crypt abscesses in more inflamed areas in keeping with active chronic inflammatory bowel disease.
Bloods 2022: High platelets, anaemia, iron deficient.

Plan:
1. Flexible sigmoidoscopy - 2 week wait
2. Course of steroids - Clipper
3. Bloods for Pre-immunologic screening and flare
(FBC, UE, LFT, CRP, Cholesterol, TSH, TPMT, CMV (IgG and IgM), EBV (IgG and IgM), VZV (IgG and IgM), Hep B Core and surface, Hep C Antibody, Hep A, HIV)
4. Consideration of systemic treatment with results of pre-immunologic screen, flexible sigmoidoscopy and blood tests
5. Trial of 5-ASA suppositories
6. Ensure up to date with cervical screening
7. CXR as part of pre-immunologic screening
8. Vaccinations: Influenza and pneumococcus

I had the pleasure of speaking on the telephone to Mrs Froude today on behalf of Dr Hayward in IBD clinic.

She was diagnosed with left-sided ulcerative colitis in June 2022. She required steroids at her initial diagnosis and subsequently started on Octasa 2.4g. Unfortunately, she found the Octasa gave her diarrhoea, which I explained can sometimes happen with this medicine, and so she was not able to take it and stopped it.

Since then, she's had good and bad days with occasional stomach cramps and occasional loose stools, however something that she finds tolerable.

Unfortunately, over the last 4 to 6 weeks she's been having significant urgency after eating, passing a watery type 7 stool with occasional visible blood 6 times a day. She hasn't had any fevers but she is feeling tired and lethargic alongside it.

She's noticed that she's lost some weight over the last few months, her clothes are looser, but she doesn't weigh herself and she's avoiding food because she lacks an appetite and also because she's trying to improve her symptoms by restricting.

In terms of her life more generally, she has 3 young boys and works a desk job from home most of the time, however is required to go into the office occasionally, which she understandably finds difficult given her bowel habit.

She doesn't smoke and doesn't drink alcohol excessively.

We discussed today that it's likely that she's had ongoing bowel inflammation for some time and it doesn't sound like we've ever got complete control of it apart from when we gave her steroids.

I explained that we want to control her symptoms in order to allow her to live a full life, but we also want to decrease bowel inflammation in order to decrease her risk of developing malignancy in the future.

Without any blood tests, she's a moderate on the Truelove and Witts criteria for flare of ulcerative colitis, and so I'll send her out some 5-ASA suppositories, which I hope will help her left-sided proctitis symptoms, as well as a course of steroids to dampen down any underlying inflammation. I'll request an urgent flexible sigmoidoscopy for her to assess her disease activity as well as some blood tests, and with these things we can establish whether escalation of treatment and consideration of thiopurines would be sensible for her given her intolerance to 5-ASA therapy.

I look forward to discussing with her again in 6 weeks' time with the results of investigations.

Summary

Investigations

Plans

Nothing here...