Ulcerative colitis: Difference between revisions
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*Rectum is almost always involved | *Rectum is almost always involved | ||
*Peak incidence occurs in second and third decades of life | *Peak incidence occurs in second and third decades of life | ||
{{Crohn's vs UC}} | |||
==Clinical Features== | ==Clinical Features== | ||
*Abdominal cramps and diarrhea (often bloody) | *[[abdominal pain|Abdominal cramps]] and [[diarrhea]] (often [[rectal bleeding|bloody]]) | ||
===Classification=== | ===Classification=== | ||
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**<4 bowel movements per day | **<4 bowel movements per day | ||
**No systemic symptoms | **No systemic symptoms | ||
**Few extraintestinal | **Few extraintestinal manifestations | ||
**Occasional constipation and rectal bleeding | **Occasional constipation and rectal bleeding | ||
*Moderate | *Moderate | ||
**Colitis extends to splenic flexure | **[[Colitis]] extends to splenic flexure | ||
*Severe | *Severe | ||
**Frequent BM | **Frequent BM | ||
**[[Anemia]] | **[[Anemia]] | ||
**[[Fever]] | **[[Fever]] | ||
** | **Weight loss | ||
**Frequent extraintestinal manifestations | **Frequent extraintestinal manifestations | ||
**Pancolitis | **[[colitis|Pancolitis]] | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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===Work-up=== | ===Work-up=== | ||
*CBC | *CBC | ||
*Chemistry | *Chemistry | ||
*LFTs/lipase | |||
*Consider: | |||
**ESR/CRP | |||
**Fecal calprotectin<ref>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.</ref> (typically requested by GI) | |||
**Type and screen (if significant bleeding) | |||
*Imaging | *Imaging | ||
**Consider CT based on clinical features | **Consider CT based on clinical features and need to rule out more concerning processes | ||
===Diagnosis=== | |||
*Positive atypical p-ANCA and negative ASCA is specific for ulcerative colitis | |||
==Management== | ==Management== | ||
#Rule-out complications: | #Rule-out complications: | ||
#*Hemorrhage | #*[[GI bleed|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 | ||
#**Presentation | #**Presentation | ||
#***Severely ill | #***Severely ill | ||
#*** | #***Abdomen distended, tender, [[peritonitis]] | ||
#***Fever, tachycardia | #***[[Fever]], [[tachycardia]] | ||
#***Leukocytosis (may be masked if patient taking steroids) | #***[[Leukocytosis]] (may be masked if patient taking steroids) | ||
#**Perforation results in high mortality | #**Perforation results in high mortality | ||
#** | #**[[Abdominal x-ray]]: long, continuous segment of air-filled colon >6cm in diameter | ||
#*Perirectal fistula | #*[[anal fistula|Perirectal fistula]] | ||
#* | #*[[Anorectal abscess|Perirectal abscess]] | ||
#*Obstruction (due to stricture) | #*Obstruction (due to stricture) | ||
#*Carcinoma | #*[[colon cancer|Carcinoma]] | ||
#Steroids | #[[Steroids]] | ||
#*Parenteral vs PO depending on severity | #*Parenteral vs PO depending on severity | ||
#**PO: 40mg x 2wks, then decrease by 5mg per week | #**PO: [[prednisone]] 40mg x 2wks, then decrease by 5mg per week | ||
==Disposition== | ==Disposition== | ||
Latest revision as of 17:55, 7 September 2022
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
Crohn's disease vs. ulcerative colitis
| Finding | Crohn's disease | Ulcerative colitis |
| Depth of inflammation | May be transmural, deep into tissues | Shallow, mucosal |
| Distribution of disease | Patchy areas of inflammation (skip lesions) | Continuous area of inflammation |
| Terminal ileum involvement | Commonly | Seldom |
| Colon involvement | Usually | Always |
| Rectum involvement | Seldom | Usually (95%) |
| Involvement around anus | Common | Seldom |
| Stenosis | Common | Seldom |
Clinical Features
- Abdominal cramps and diarrhea (often bloody)
Classification
- Mild
- <4 bowel movements per day
- No systemic symptoms
- Few extraintestinal manifestations
- Occasional constipation and rectal bleeding
- Moderate
- Colitis extends to splenic flexure
- Severe
- Frequent BM
- Anemia
- Fever
- Weight loss
- Frequent extraintestinal manifestations
- Pancolitis
Differential Diagnosis
Colitis
- Infectious colitis
- Ischemic colitis
- Ulcerative colitis
- CMV colitis
- Crohn's colitis
- Toxic colitis (antineoplastic agents)
- Pseudomembranous colitis
- Fibrosing colonopathy (Cystic fibrosis)
Evaluation
Work-up
- CBC
- Chemistry
- LFTs/lipase
- Consider:
- ESR/CRP
- Fecal calprotectin[1] (typically requested by GI)
- Type and screen (if significant bleeding)
- Imaging
- Consider CT based on clinical features and need to rule out more concerning processes
Diagnosis
- Positive atypical p-ANCA and negative ASCA is specific for ulcerative colitis
Management
- Rule-out complications:
- Hemorrhage
- Toxic megacolon
- Develops in advanced disease when all the layers of the colon become involved
- Presentation
- Severely ill
- Abdomen distended, tender, peritonitis
- Fever, tachycardia
- Leukocytosis (may be masked if patient taking steroids)
- Perforation results in high mortality
- Abdominal 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: prednisone 40mg x 2wks, then decrease by 5mg per week
- Parenteral vs PO depending on severity
Disposition
- Admit for severe complication or severe flare requiring IV steroids
See Also
References
- ↑ 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.