Difference between revisions of "Ulcerative colitis"

(added prednisone taper)
(Text replacement - "abscess " to "abscess ")
 
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== Background ==
+
==Background==
 
 
 
*Inflammation tends to be progressively more severe from proximal to distal colon  
 
*Inflammation tends to be progressively more severe from proximal to distal colon  
 
*Rectum is almost always involved  
 
*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 ==
+
==Clinical Features==
 +
*Abdominal cramps and diarrhea (often bloody)
  
*Abdominal cramps and diarrhea (often bloody)
+
===Classification===
*Classification  
+
*Mild  
**Mild  
+
**<4 bowel movements per day
***&lt;4 BM/d
+
**No systemic symptoms  
***No systemic symptoms  
+
**Few extraintestinal manifestaions  
***Few extraintestinal manifestaions  
+
**Occasional constipation and rectal bleeding  
***Occasional constipation and rectal bleeding  
+
*Moderate  
**Moderate  
+
**Colitis extends to splenic flexure  
***Colitis extends to splenic flexure  
+
*Severe  
**Severe  
+
**Frequent BM  
***Frequent BM  
+
**[[Anemia]]
***Anemia  
+
**[[Fever]]
***Fever  
+
**Wt loss  
***Wt loss  
+
**Frequent extraintestinal manifestations  
***Frequent extraintestinal manifestations  
+
**Pancolitis
***Pancolitis
 
  
== Work-Up ==
+
==Differential Diagnosis==
 +
{{Colitis types}}
  
*Labs
+
==Evaluation==
**CBC  
+
===Work-up===
**Chemistry  
+
*CBC  
 +
*Chemistry  
 
*Imaging  
 
*Imaging  
**?Abd x-ray
+
**Consider CT based on clinical features
**?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 &gt;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 ==
+
==Management==
 +
#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, peritonitis
 +
#***Fever, tachycardia
 +
#***Leukocytosis (may be masked if patient 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
 +
#Steroids
 +
#*Parenteral vs PO depending on severity
 +
#**PO: 40mg x 2wks, then decrease by 5mg per week
  
== See Also ==
+
==Disposition==
 +
*Admit for severe complication or severe flare requiring IV steroids
  
== Source ==
+
==See Also==
 +
*[[Colitis]]
  
Tintinalli
+
==References==
 +
<references/>
  
 
[[Category:GI]]
 
[[Category:GI]]

Latest revision as of 15:54, 10 March 2017

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

Clinical Features

  • Abdominal cramps and diarrhea (often bloody)

Classification

  • Mild
    • <4 bowel movements per day
    • 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

Differential Diagnosis

Colitis

Evaluation

Work-up

  • CBC
  • Chemistry
  • Imaging
    • Consider CT based on clinical features

Management

  1. 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, peritonitis
        • Fever, tachycardia
        • Leukocytosis (may be masked if patient 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
  2. Steroids
    • Parenteral vs PO depending on severity
      • PO: 40mg x 2wks, then decrease by 5mg per week

Disposition

  • Admit for severe complication or severe flare requiring IV steroids

See Also

References