Difference between revisions of "Ulcerative colitis"

(Management)
 
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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==
 
==Clinical Features==
*Abdominal cramps and diarrhea (often bloody)  
+
*[[abdominal pain|Abdominal cramps]] and [[diarrhea]] (often [[rectal bleeding|bloody]])  
  
 
===Classification===
 
===Classification===
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**<4 bowel movements per day
 
**<4 bowel movements per day
 
**No systemic symptoms  
 
**No systemic symptoms  
**Few extraintestinal manifestaions
+
**Few extraintestinal manifestations
 
**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  
+
**Weight loss  
 
**Frequent extraintestinal manifestations  
 
**Frequent extraintestinal manifestations  
**Pancolitis
+
**Pan[[colitis]]
  
== Differential Diagnosis==
+
==Differential Diagnosis==
 
{{Colitis types}}
 
{{Colitis types}}
  
== Diagnosis ==
+
==Evaluation==
*Labs
+
===Work-up===
**CBC
+
*CBC
**Chemistry
+
*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
 
  
== Treatment ==
+
==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  
#***Abd distended, tender, peritonitic
+
#***Abdomen distended, tender, [[peritonitis]]
#***Fever, tachycardia  
+
#***[[Fever]], [[tachycardia]]
#***Leukocytosis (may be masked if pt taking steroids)  
+
#***[[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 &gt;6cm in diameter  
+
#**[[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 ==
+
==Disposition==
 
*Admit for severe complication or severe flare requiring IV steroids
 
*Admit for severe complication or severe flare requiring IV steroids
  
== See Also ==
+
==See Also==
 
*[[Colitis]]
 
*[[Colitis]]
  
== Source ==
+
==References==
 
+
<references/>
Tintinalli
 
  
 
[[Category:GI]]
 
[[Category:GI]]

Latest 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

Classification

  • Mild
    • <4 bowel movements per day
    • No systemic symptoms
    • Few extraintestinal manifestations
    • Occasional constipation and rectal bleeding
  • Moderate
  • Severe

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:
  2. Steroids
    • Parenteral vs PO depending on severity
      • PO: prednisone 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.