Ulcerative colitis: Difference between revisions
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== Treatment == | == Treatment == | ||
*1. Rule-out complications: | |||
*Rule-out complications | **Hemorrhage | ||
**Hemorrhage | |||
**Toxic megacolon | **Toxic megacolon | ||
***Develops in advanced disease when all the layers of the colon become involved | ***Develops in advanced disease when all the layers of the colon become involved | ||
Line 59: | Line 58: | ||
**Obstruction (due to stricture) | **Obstruction (due to stricture) | ||
**Carcinoma | **Carcinoma | ||
* | *Steroids | ||
**Parenteral vs PO depending on severity | |||
***PO: 40mg x 2wks, then decrease by 5mg per week | |||
== Disposition == | == Disposition == |
Revision as of 18:08, 1 November 2012
Background
- Inflammation tends to be progressively more severe from proximal to distal colon
- Rectum is almost always involved
- Peak incidence occurs in second and third decades of life
Diagnosis
- Abdominal cramps and diarrhea (often bloody)
- Classification
- Mild
- <4 BM/d
- No systemic symptoms
- Few extraintestinal manifestaions
- Occasional constipation and rectal bleeding
- Moderate
- Colitis extends to splenic flexure
- Severe
- Frequent BM
- Anemia
- Fever
- Wt loss
- Frequent extraintestinal manifestations
- Pancolitis
- Mild
Work-Up
- Labs
- CBC
- Chemistry
- Imaging
- ?Abd x-ray
- ?CT A/P
DDx
- Infectious colitis
- Crohn's colitis
- Ischemic colitis
- Toxic colitis (antineoplastic agents)
- Pseudomembranous colitis
- Gonococcal proctitis
Treatment
- 1. Rule-out complications:
- Hemorrhage
- Toxic megacolon
- Develops in advanced disease when all the layers of the colon become involved
- Presentation
- Severely ill
- Abd distended, tender, peritonitic
- Fever, tachycardia
- Leukocytosis (may be masked if pt taking steroids)
- Perforation results in high mortality
- Abd x-ray: long, continuous segment of air-filled colon >6cm in diameter
- Perirectal fistula
- Perirectal abscess
- Obstruction (due to stricture)
- Carcinoma
- Steroids
- Parenteral vs PO depending on severity
- PO: 40mg x 2wks, then decrease by 5mg per week
- Parenteral vs PO depending on severity
Disposition
See Also
Source
Tintinalli