Difference between revisions of "Ulcerative colitis"

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{{Colitis types}}
 
{{Colitis types}}
  
==Diagnosis==
+
==Evaluation==
 
===Work-up===
 
===Work-up===
 
*CBC  
 
*CBC  
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#***Abd distended, tender, peritonitis  
 
#***Abd distended, tender, peritonitis  
 
#***Fever, tachycardia  
 
#***Fever, tachycardia  
#***Leukocytosis (may be masked if pt taking steroids)  
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#***Leukocytosis (may be masked if patient taking steroids)  
 
#**Perforation results in high mortality  
 
#**Perforation results in high mortality  
#**Abd x-ray: long, continuous segment of air-filled colon >6cm in diameter  
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#**Abd x-ray: long, continuous segment of air-filled colon >6cm in diameter  
 
#*Perirectal fistula  
 
#*Perirectal fistula  
#*Perirectal abscess  
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#*Perirectal [[abscess]]
 
#*Obstruction (due to stricture)  
 
#*Obstruction (due to stricture)  
 
#*Carcinoma  
 
#*Carcinoma  

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