Ulcerative colitis

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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

DDx

  1. Infectious colitis
  2. Crohn's colitis
  3. Ischemic colitis
  4. Toxic colitis (antineoplastic agents)
  5. Pseudomembranous colitis
  6. 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 >6cm in diameter
    • Perirectal fistula
    • Perirectal abscess
    • Obstruction (due to stricture)
    • Carcinoma

Disposition

See Also

Source

Tintinalli