Ulcerative colitis

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
  • 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