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

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

Source

Tintinalli