Difference between revisions of "Ulcerative colitis"

(Management)
 
Line 49: Line 49:
 
#**[[Abdominal x-ray]]: long, continuous segment of air-filled colon >6cm in diameter  
 
#**[[Abdominal x-ray]]: long, continuous segment of air-filled colon >6cm in diameter  
 
#*[[anal fistula|Perirectal fistula]]  
 
#*[[anal fistula|Perirectal fistula]]  
#*[[perirectal Abscess|Perirectal abscess]]  
+
#*[[Anorectal abscess|Perirectal abscess]]  
 
#*Obstruction (due to stricture)  
 
#*Obstruction (due to stricture)  
 
#*[[colon cancer|Carcinoma]]  
 
#*[[colon cancer|Carcinoma]]  

Latest revision as of 16:43, 30 September 2019

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

Clinical Features

Classification

  • Mild
    • <4 bowel movements per day
    • No systemic symptoms
    • Few extraintestinal manifestations
    • Occasional constipation and rectal bleeding
  • Moderate
  • Severe

Differential Diagnosis

Colitis

Evaluation

Work-up

  • CBC
  • Chemistry
  • ESR/CRP
  • Fecal calprotectin[1] (typically requested by GI)
  • Type and screen
  • Imaging
    • Consider CT based on clinical features

Management

  1. Rule-out complications:
  2. Steroids
    • Parenteral vs PO depending on severity
      • PO: prednisone 40mg x 2wks, then decrease by 5mg per week

Disposition

  • Admit for severe complication or severe flare requiring IV steroids

See Also

References

  1. van Rheenen PF, Van de Vijver E, Fidler V. Faecal calprotectin for screening of patients with suspected inflammatory bowel disease: diagnostic meta-analysis. BMJ. 2010;15(341):c3369.