Ulcerative colitis: Difference between revisions
(added prednisone taper) |
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****Leukocytosis (may be masked if pt taking steroids) | ****Leukocytosis (may be masked if pt taking steroids) | ||
***Perforation results in high mortality | ***Perforation results in high mortality | ||
***Abd x-ray: | ***Abd x-ray: long, continuous segment of air-filled colon >6cm in diameter | ||
**Perirectal fistula | **Perirectal fistula | ||
**Perirectal abscess | **Perirectal abscess | ||
**Obstruction (due to stricture) | **Obstruction (due to stricture) | ||
**Carcinoma | **Carcinoma | ||
*Prednisone | *Prednisone taper: 40mg x 2 weeks, then decrease by 5mg per week | ||
== Disposition == | == Disposition == |
Revision as of 18:06, 1 November 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
- Mild
Work-Up
- Labs
- CBC
- Chemistry
- Imaging
- ?Abd x-ray
- ?CT A/P
DDx
- Infectious colitis
- Crohn's colitis
- Ischemic colitis
- Toxic colitis (antineoplastic agents)
- Pseudomembranous colitis
- 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