Difference between revisions of "Ulcerative colitis"

(added prednisone taper)
(Work-up)
 
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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
 +
*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  
**?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 02:15, 15 June 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 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
  • ESR/CRP
  • Fecal calprotectin[1] (typically requested by GI)
  • Type and screen
  • 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

  1. 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.