Difference between revisions of "Ulcerative colitis"

(DDx)
(Treatment)
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== Treatment ==
 
== Treatment ==
*1. Rule-out complications:
+
#Rule-out complications:
**Hemorrhage
+
#*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  
****Abd distended, tender, peritonitic  
+
#***Abd distended, tender, peritonitic  
****Fever, tachycardia  
+
#***Fever, tachycardia  
****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: long, continuous segment of air-filled colon >6cm in diameter  
+
#**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  
*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: 40mg x 2wks, then decrease by 5mg per week
  
 
== Disposition ==
 
== Disposition ==

Revision as of 19:12, 11 May 2015

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

Work-Up

  • Labs
    • CBC
    • Chemistry
  • Imaging
    • ?Abd x-ray
    • ?CT A/P

Differential Diagnosis

Colitis

Treatment

  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, 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
  2. Steroids
    • Parenteral vs PO depending on severity
      • PO: 40mg x 2wks, then decrease by 5mg per week

Disposition

See Also

Source

Tintinalli