Toxic megacolon: Difference between revisions
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*Untreated, can lead to perforation | *Untreated, can lead to perforation | ||
*Usually associated with infectious colitis or [[Crohn's disease]] or [[Ulcerative Colitis]] | *Usually associated with infectious colitis or [[Crohn's disease]] or [[Ulcerative Colitis]] | ||
===Triggers=== | |||
*Anti-motility agents | |||
*Anticholinergics | |||
*Narcotics | |||
*Pregnancy | |||
*Enemas | |||
*Recent colonoscopy | |||
==Clinical Features== | ==Clinical Features== | ||
*Abdominal Pain | *[[Abdominal Pain]] | ||
*Fever | *[[Fever]] | ||
*Tachycardia | *[[Tachycardia]] | ||
*Diarrhea | *[[Diarrhea]] | ||
*Distended abdomen | *Distended abdomen | ||
*Hypokalemia | *[[Hypokalemia]] | ||
*Hypomagnesemia | *[[Hypomagnesemia]] | ||
* | *[[Bowel perforation]] | ||
**Peritonitis | **[[Peritonitis]] | ||
**Septicemia | **[[Septicemia]] | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Management== | ==Management== | ||
*Fluid hydration | *Fluid hydration | ||
*IV corticosteroids | *IV [[corticosteroids]] | ||
*Antibiotics to cover bowel flora<ref>Rosen's Emergency Medicine. Philadelphia, PA. 2014.</ref> | *Antibiotics to cover bowel flora<ref>Rosen's Emergency Medicine. Philadelphia, PA. 2014.</ref> | ||
**Mild to moderate disease | **Mild to moderate disease | ||
*** | ***[[Ciprofloxacin]] 400 mg IV q12h AND [[metronidazole]] 1 g IV q12h | ||
*** | ***[[Ticarcillin-clavulanate]] 3.1 g IV q6h | ||
**Severe disease | **Severe disease | ||
*** | ***[[Ampicillin]] 2 g IV q6h AND [[metronidazole]] 500 mg IV q6h AND [[gentamicin]] 7mg/kg q24h | ||
***Imipenem 500 mg IV q6h | ***[[Imipenem]] 500 mg IV q6h | ||
*Early surgical consultation if no improvement in 24-48 hours | *Early surgical consultation if no improvement in 24-48 hours | ||
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==See Also== | ==See Also== | ||
[[Crohn's disease]] | *[[Crohn's disease]] | ||
[[Ulcerative Colitis]] | *[[Ulcerative Colitis]] | ||
==External Links== | ==External Links== | ||
Revision as of 02:02, 16 September 2015
Background
- Inflammation of intestinal smooth muscle causes colon dilation[1]
- Untreated, can lead to perforation
- Usually associated with infectious colitis or Crohn's disease or Ulcerative Colitis
Triggers
- Anti-motility agents
- Anticholinergics
- Narcotics
- Pregnancy
- Enemas
- Recent colonoscopy
Clinical Features
- Abdominal Pain
- Fever
- Tachycardia
- Diarrhea
- Distended abdomen
- Hypokalemia
- Hypomagnesemia
- Bowel perforation
Differential Diagnosis
- Small bowel obstruction
- Large Bowel Obstruction
- Constipation
- C. difficile colitis
Diagnosis
- X-ray showing colon > 6 cm diameter
- Can also see loss of haustra, "thumb-printing" (bowel edema)
- Labs:
- leukocytosis
- electrolyte disturbances
- anemia
- hypoalbuminemia
Management
- Fluid hydration
- IV corticosteroids
- Antibiotics to cover bowel flora[2]
- Mild to moderate disease
- Ciprofloxacin 400 mg IV q12h AND metronidazole 1 g IV q12h
- Ticarcillin-clavulanate 3.1 g IV q6h
- Severe disease
- Ampicillin 2 g IV q6h AND metronidazole 500 mg IV q6h AND gentamicin 7mg/kg q24h
- Imipenem 500 mg IV q6h
- Mild to moderate disease
- Early surgical consultation if no improvement in 24-48 hours
Disposition
- Admit