Difference between revisions of "Ulcerative colitis"

(Treatment)
Line 5: Line 5:
 
*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
 
**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 ==
+
===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 types}}
  
 +
== Diagnosis ==
 
*Labs  
 
*Labs  
 
**CBC  
 
**CBC  
Line 32: Line 35:
 
**?Abd x-ray  
 
**?Abd x-ray  
 
**?CT A/P
 
**?CT A/P
 
== Differential Diagnosis==
 
{{Colitis types}}
 
  
 
== Treatment ==
 
== Treatment ==

Revision as of 19:14, 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


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

Diagnosis

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

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