Toxic megacolon: Difference between revisions
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==Management== | ==Management== | ||
*Fluid hydration | |||
*IV corticosteroids | |||
*Antibiotics to cover bowel flora | |||
**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 | |||
*Early surgical consultation if no improvement in 24-48 hours | |||
==Disposition== | ==Disposition== | ||
Revision as of 00:14, 15 September 2015
Background
- Inflammation of intestinal smooth muscle causes colon dilation
- 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
- Perforation
- Peritonitis
- Septicemia
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
- 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