Ulcerative colitis

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

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

Management

1. 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
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

• Colitis