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  
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**Obstruction (due to stricture)  
**Obstruction (due to stricture)  
**Carcinoma  
**Carcinoma  
*Prednisone taper: 40mg x 2 weeks, then decrease by 5mg per week
*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

Work-Up

  • Labs
    • CBC
    • Chemistry
  • Imaging
    • ?Abd x-ray
    • ?CT A/P

DDx

  1. Infectious colitis
  2. Crohn's colitis
  3. Ischemic colitis
  4. Toxic colitis (antineoplastic agents)
  5. Pseudomembranous colitis
  6. 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

Disposition

See Also

Source

Tintinalli