Ulcerative colitis: Difference between revisions
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Revision as of 17:22, 12 September 2014
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