Ulcerative colitis: Difference between revisions
Elcatracho (talk | contribs) |
|||
| Line 3: | Line 3: | ||
*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 | ||
{{Crohn's vs UC}} | |||
==Clinical Features== | ==Clinical Features== | ||
Revision as of 21:18, 7 July 2021
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
Crohn's disease vs. ulcerative colitis
| Finding | Crohn's disease | Ulcerative colitis |
| Depth of inflammation | May be transmural, deep into tissues | Shallow, mucosal |
| Distribution of disease | Patchy areas of inflammation (skip lesions) | Continuous area of inflammation |
| Terminal ileum involvement | Commonly | Seldom |
| Colon involvement | Usually | Always |
| Rectum involvement | Seldom | Usually (95%) |
| Involvement around anus | Common | Seldom |
| Stenosis | Common | Seldom |
Clinical Features
- Abdominal cramps and diarrhea (often bloody)
Classification
- Mild
- <4 bowel movements per day
- No systemic symptoms
- Few extraintestinal manifestations
- Occasional constipation and rectal bleeding
- Moderate
- Colitis extends to splenic flexure
- Severe
- Frequent BM
- Anemia
- Fever
- Weight loss
- Frequent extraintestinal manifestations
- Pancolitis
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.