Difference between revisions of "Ulcerative colitis"

(Work-Up)
(added prednisone taper)
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==Background==
+
== Background ==
*Inflammation tends to be progressively more severe from proximal to distal colon
+
 
*Rectum is almost always involved
+
*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
 
*Peak incidence occurs in second and third decades of life
  
==Diagnosis==
+
== Diagnosis ==
*Abdominal cramps and diarrhea (often bloody)
+
 
*Classification
+
*Abdominal cramps and diarrhea (often bloody)  
**Mild
+
*Classification  
***<4 BM/d
+
**Mild  
***No systemic symptoms
+
***&lt;4 BM/d  
***Few extraintestinal manifestaions
+
***No systemic symptoms  
***Occasional constipation and rectal bleeding
+
***Few extraintestinal manifestaions  
**Moderate
+
***Occasional constipation and rectal bleeding  
***Colitis extends to splenic flexure
+
**Moderate  
**Severe
+
***Colitis extends to splenic flexure  
***Frequent BM
+
**Severe  
***Anemia
+
***Frequent BM  
***Fever
+
***Anemia  
***Wt loss
+
***Fever  
***Frequent extraintestinal manifestations
+
***Wt loss  
 +
***Frequent extraintestinal manifestations  
 
***Pancolitis
 
***Pancolitis
  
==Work-Up==
+
== Work-Up ==
*Labs
+
 
**CBC
+
*Labs  
**Chemistry
+
**CBC  
*Imaging
+
**Chemistry  
**?Abd x-ray
+
*Imaging  
 +
**?Abd x-ray  
 
**?CT A/P
 
**?CT A/P
  
==DDx==
+
== DDx ==
#Infectious colitis
+
 
#Crohn's colitis
+
#Infectious colitis  
#Ischemic colitis
+
#Crohn's colitis  
#Toxic colitis (antineoplastic agents)
+
#Ischemic colitis  
#Pseudomembranous colitis
+
#Toxic colitis (antineoplastic agents)  
 +
#Pseudomembranous colitis  
 
#Gonococcal proctitis
 
#Gonococcal proctitis
  
==Treatment==
+
== Treatment ==
*Rule-out complications
+
 
**Hemorrhage
+
*Rule-out complications  
**Toxic megacolon
+
**Hemorrhage  
***Develops in advanced disease when all the layers of the colon become involved
+
**Toxic megacolon  
***Presentation
+
***Develops in advanced disease when all the layers of the colon become involved  
****Severely ill
+
***Presentation  
****Abd distended, tender, peritonitic
+
****Severely ill  
****Fever, tachycardia
+
****Abd distended, tender, peritonitic  
****Leukocytosis (may be masked if pt taking steroids)
+
****Fever, tachycardia  
***Perforation results in high mortality
+
****Leukocytosis (may be masked if pt taking steroids)  
***Abd x-ray: Long, continuous segment of air-filled colon >6cm in diameter
+
***Perforation results in high mortality  
**Perirectal fistula
+
***Abd x-ray: Long, continuous segment of air-filled colon &gt;6cm in diameter  
**Perirectal abscess
+
**Perirectal fistula  
**Obstruction (due to stricture)
+
**Perirectal abscess  
**Carcinoma
+
**Obstruction (due to stricture)  
 +
**Carcinoma  
 +
*Prednisone Taper: 40mg x 2 weeks, then decrease by 5mg per week.
 +
 
 +
== Disposition ==
  
==Disposition==
+
== See Also ==
  
==See Also==
+
== Source ==
  
==Source==
+
Tintinalli  
Tintinalli
 
  
 
[[Category:GI]]
 
[[Category:GI]]

Revision as of 05:43, 16 August 2012

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

Work-Up

  • Labs
    • CBC
    • Chemistry
  • Imaging
    • ?Abd x-ray
    • ?CT A/P

DDx

  1. Infectious colitis
  2. Crohn's colitis
  3. Ischemic colitis
  4. Toxic colitis (antineoplastic agents)
  5. Pseudomembranous colitis
  6. Gonococcal proctitis

Treatment

  • 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
  • Prednisone Taper: 40mg x 2 weeks, then decrease by 5mg per week.

Disposition

See Also

Source

Tintinalli