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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
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
Classification
- Mild
- <4 bowel movements per day
- No systemic symptoms
- Few extraintestinal manifestations
- Occasional constipation and rectal bleeding
- Moderate
- Severe
Differential Diagnosis
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:
- 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
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.