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)
Differential Diagnosis
Colitis
- Infectious colitis
- Ischemic colitis
- Ulcerative colitis
- CMV colitis
- Crohn's colitis
- Toxic colitis (antineoplastic agents)
- Pseudomembranous colitis
- Fibrosing colonopathy (Cystic fibrosis)
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
- Rule-out complications:
- Hemorrhage
- Toxic megacolon
- Develops in advanced disease when all the layers of the colon become involved
- Presentation
- Severely ill
- Abdomen distended, tender, peritonitis
- Fever, tachycardia
- Leukocytosis (may be masked if patient taking steroids)
- Perforation results in high mortality
- Abdominal x-ray: long, continuous segment of air-filled colon >6cm in diameter
- Perirectal fistula
- Perirectal abscess
- Obstruction (due to stricture)
- Carcinoma
- Steroids
- Parenteral vs PO depending on severity
- PO: prednisone 40mg x 2wks, then decrease by 5mg per week
- Parenteral vs PO depending on severity
Disposition
- Admit for severe complication or severe flare requiring IV steroids
See Also
References
- 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.
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