Difference between revisions of "Ulcerative colitis"

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(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
 
**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==
+
===Classification===
*Labs
+
*Mild
**CBC
+
**<4 bowel movements per day
**Chemistry
+
**No systemic symptoms
*Imaging
+
**Few extraintestinal manifestaions
**?Abd x-ray
+
**Occasional constipation and rectal bleeding
**?CT A/P
+
*Moderate
 +
**Colitis extends to splenic flexure
 +
*Severe
 +
**Frequent BM
 +
**[[Anemia]]
 +
**[[Fever]]
 +
**Wt loss
 +
**Frequent extraintestinal manifestations
 +
**Pancolitis
  
==DDx==
+
==Differential Diagnosis==
#Infectious colitis
+
{{Colitis types}}
#Crohn's colitis
 
#Ischemic colitis
 
#Toxic colitis (antineoplastic agents)
 
#Pseudomembranous colitis
 
#Gonococcal proctitis
 
  
==Treatment==
+
==Evaluation==
*Rule-out complications
+
===Work-up===
**Hemorrhage
+
*CBC
**Toxic megacolon
+
*Chemistry
***Develops in advanced disease when all the layers of the colon become involved
+
*Imaging
***Presentation
+
**Consider CT based on clinical features
****Severely ill
+
 
****Abd distended, tender, peritonitic
+
==Management==
****Fever, tachycardia
+
#Rule-out complications:
****Leukocytosis (may be masked if pt taking steroids)
+
#*Hemorrhage
***Perforation results in high mortality
+
#*Toxic megacolon  
***Abd x-ray: Long, continuous segment of air-filled colon >6cm in diameter
+
#**Develops in advanced disease when all the layers of the colon become involved  
**Perirectal fistula
+
#**Presentation  
**Perirectal abscess
+
#***Severely ill  
**Obstruction (due to stricture)
+
#***Abd distended, tender, peritonitis
**Carcinoma
+
#***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
  
 
==Disposition==
 
==Disposition==
 +
*Admit for severe complication or severe flare requiring IV steroids
  
 
==See Also==
 
==See Also==
 +
*[[Colitis]]
  
==Source==
+
==References==
Tintinalli
+
<references/>
  
 
[[Category:GI]]
 
[[Category:GI]]

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