Ulcerative colitis: Difference between revisions
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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 | ||
== | ==Clinical Features== | ||
*[[abdominal pain|Abdominal cramps]] and [[diarrhea]] (often [[rectal bleeding|bloody]]) | |||
===Classification=== | |||
*Mild | |||
**<4 bowel movements per day | |||
** | **No systemic symptoms | ||
**Few extraintestinal manifestations | |||
**Occasional constipation and rectal bleeding | |||
*Moderate | |||
**[[Colitis]] extends to splenic flexure | |||
** | *Severe | ||
**Frequent BM | |||
**[[Anemia]] | |||
** | **[[Fever]] | ||
** | **Weight loss | ||
** | **Frequent extraintestinal manifestations | ||
**Pan[[colitis]] | |||
** | |||
== | ==Differential Diagnosis== | ||
{{Colitis types}} | |||
* | ==Evaluation== | ||
** | ===Work-up=== | ||
** | *CBC | ||
*Chemistry | |||
*ESR/CRP | |||
*Fecal calprotectin<ref>van Rheenen PF, Van de Vijver E, Fidler V. Faecal calprotectin for screening of patients with suspected inflammatory bowel disease: diagnostic meta-analysis. BMJ. 2010;15(341):c3369.</ref> (typically requested by GI) | |||
*Type and screen | |||
*Imaging | *Imaging | ||
** | **Consider CT based on clinical features | ||
== | ==Management== | ||
#Rule-out complications: | #Rule-out complications: | ||
#*Hemorrhage | #*[[GI bleed|Hemorrhage]] | ||
#*Toxic megacolon | #*[[Toxic megacolon]] | ||
#**Develops in advanced disease when all the layers of the colon become involved | #**Develops in advanced disease when all the layers of the colon become involved | ||
#**Presentation | #**Presentation | ||
#***Severely ill | #***Severely ill | ||
#*** | #***Abdomen distended, tender, [[peritonitis]] | ||
#***Fever, tachycardia | #***[[Fever]], [[tachycardia]] | ||
#***Leukocytosis (may be masked if | #***[[Leukocytosis]] (may be masked if patient taking steroids) | ||
#**Perforation results in high mortality | #**Perforation results in high mortality | ||
#** | #**[[Abdominal x-ray]]: long, continuous segment of air-filled colon >6cm in diameter | ||
#*Perirectal fistula | #*[[anal fistula|Perirectal fistula]] | ||
#*Perirectal abscess | #*[[Anorectal abscess|Perirectal abscess]] | ||
#*Obstruction (due to stricture) | #*Obstruction (due to stricture) | ||
#*Carcinoma | #*[[colon cancer|Carcinoma]] | ||
#Steroids | #[[Steroids]] | ||
#*Parenteral vs PO depending on severity | #*Parenteral vs PO depending on severity | ||
#**PO: 40mg x 2wks, then decrease by 5mg per week | #**PO: [[prednisone]] 40mg x 2wks, then decrease by 5mg per week | ||
== | ==Disposition== | ||
*Admit for severe complication or severe flare requiring IV steroids | |||
== | ==See Also== | ||
*[[Colitis]] | |||
==References== | |||
<references/> | |||
[[Category:GI]] | [[Category:GI]] | ||
Revision as of 16:43, 30 September 2019
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 manifestations
- Occasional constipation and rectal bleeding
- Moderate
- Colitis extends to splenic flexure
- Severe
Differential Diagnosis
Colitis
- Infectious colitis
- Ischemic colitis
- Ulcerative colitis
- CMV colitis
- Crohn's colitis
- Toxic colitis (antineoplastic agents)
- Pseudomembranous colitis
- Fibrosing colonopathy (Cystic fibrosis)
Evaluation
Work-up
- CBC
- Chemistry
- ESR/CRP
- Fecal calprotectin[1] (typically requested by GI)
- Type and screen
- Imaging
- Consider CT based on clinical features
Management
- Rule-out complications:
- Hemorrhage
- Toxic megacolon
- Develops in advanced disease when all the layers of the colon become involved
- Presentation
- Severely ill
- Abdomen distended, tender, peritonitis
- Fever, tachycardia
- Leukocytosis (may be masked if patient taking steroids)
- Perforation results in high mortality
- Abdominal 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: prednisone 40mg x 2wks, then decrease by 5mg per week
- Parenteral vs PO depending on severity
Disposition
- Admit for severe complication or severe flare requiring IV steroids
See Also
References
- ↑ van Rheenen PF, Van de Vijver E, Fidler V. Faecal calprotectin for screening of patients with suspected inflammatory bowel disease: diagnostic meta-analysis. BMJ. 2010;15(341):c3369.