Difference between revisions of "Ulcerative colitis"

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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==
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**Pancolitis
 
**Pancolitis
  
== Differential Diagnosis==
+
==Differential Diagnosis==
 
{{Colitis types}}
 
{{Colitis types}}
  
== Diagnosis ==
+
==Diagnosis==
*Labs
+
===Work-up===
**CBC  
+
*CBC  
**Chemistry  
+
*Chemistry  
 
*Imaging  
 
*Imaging  
**?Abd x-ray
+
**Consider CT based on clinical features
**?CT A/P
 
  
== Treatment ==
+
==Management==
 
#Rule-out complications:
 
#Rule-out complications:
 
#*Hemorrhage
 
#*Hemorrhage
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#**Presentation  
 
#**Presentation  
 
#***Severely ill  
 
#***Severely ill  
#***Abd distended, tender, peritonitic
+
#***Abd distended, tender, peritonitis
 
#***Fever, tachycardia  
 
#***Fever, tachycardia  
 
#***Leukocytosis (may be masked if pt taking steroids)  
 
#***Leukocytosis (may be masked if pt taking steroids)  
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#**PO: 40mg x 2wks, then decrease by 5mg per week
 
#**PO: 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]]

Revision as of 10:14, 21 February 2016

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

Work-up

  • CBC
  • Chemistry
  • 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 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

  • Admit for severe complication or severe flare requiring IV steroids

See Also

References