Ulcerative colitis: Difference between revisions
 
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==Background==
==Background==
*Inflammation tends to be progressively more severe from proximal to distal colon
[[File:Diameters of the large intestine.png|thumb|Average inner diameters and ranges of different sections of the large intestine.<ref> Nguyen H, Loustaunau C, Facista A, Ramsey L, Hassounah N, Taylor H, et al. (July 2010). "Deficient Pms2, ERCC1, Ku86, CcOI in field defects during progression to colon cancer". Journal of Visualized Experiments (41). doi:10.3791/1931. PMC 3149991. PMID 20689513.</ref>]]
*Rectum is almost always involved
*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
*Peak incidence occurs in second and third decades of life


==Diagnosis==
{{Crohn's vs UC}}
*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==
==Clinical Features==
*Labs
*[[abdominal pain|Abdominal cramps]] and [[diarrhea]] (often [[rectal bleeding|bloody]])
**CBC
**Chemistry
*Imaging
**?Abd x-ray
**?CT A/P


==DDx==
===Classification===
#Infectious colitis
*Mild
#Crohn's colitis
**<4 bowel movements per day
#Ischemic colitis
**No systemic symptoms
#Toxic colitis (antineoplastic agents)
**Few extraintestinal manifestations
#Pseudomembranous colitis
**Occasional constipation and rectal bleeding
#Gonococcal proctitis
*Moderate
**[[Colitis]] extends to splenic flexure
*Severe
**Frequent BM
**[[Anemia]]
**[[Fever]]
**Weight loss
**Frequent extraintestinal manifestations
**[[colitis|Pancolitis]]


==Treatment==
==Differential Diagnosis==
*Rule-out complications
{{Colitis types}}
**Hemorrhage
 
**Toxic megacolon
==Evaluation==
***Develops in advanced disease when all the layers of the colon become involved
===Work-up===
***Presentation
*CBC
****Severely ill
*Chemistry
****Abd distended, tender, peritonitic
*LFTs/lipase
****Fever, tachycardia
*Consider:
****Leukocytosis (may be masked if pt taking steroids)
**ESR/CRP
***Perforation results in high mortality
**Fecal calprotectin<ref>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.</ref> (typically requested by GI)
***Abd x-ray: Long, continuous segment of air-filled colon >6cm in diameter
**Type and screen (if significant bleeding)
**Perirectal fistula
*Imaging
**Perirectal abscess
**Consider CT based on clinical features and need to rule out more concerning processes
**Obstruction (due to stricture)
 
**Carcinoma
===Diagnosis===
*Positive atypical p-ANCA and negative ASCA is specific for ulcerative colitis
 
==Management==
#Rule-out complications:
#*[[GI bleed|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  
#*[[anal fistula|Perirectal fistula]]
#*[[Anorectal abscess|Perirectal abscess]]
#*Obstruction (due to stricture)  
#*[[colon cancer|Carcinoma]]
#[[Steroids]]
#*Parenteral vs PO depending on severity
#**PO: [[prednisone]] 40mg x 2wks, then decrease by 5mg per week


==Disposition==
==Disposition==
*Admit for severe complication or severe flare requiring IV steroids


==See Also==
==See Also==
*[[Colitis]]


==Source==
==References==
Tintinalli
<references/>


[[Category:GI]]
[[Category:GI]]

Latest revision as of 21:01, 24 September 2025

Background

Average inner diameters and ranges of different sections of the large intestine.[1]
  • 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

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

Classification

  • Mild
    • <4 bowel movements per day
    • No systemic symptoms
    • Few extraintestinal manifestations
    • Occasional constipation and rectal bleeding
  • Moderate
  • Severe

Differential Diagnosis

Colitis

Evaluation

Work-up

  • CBC
  • Chemistry
  • LFTs/lipase
  • Consider:
    • ESR/CRP
    • Fecal calprotectin[2] (typically requested by GI)
    • Type and screen (if significant bleeding)
  • Imaging
    • Consider CT based on clinical features and need to rule out more concerning processes

Diagnosis

  • Positive atypical p-ANCA and negative ASCA is specific for ulcerative colitis

Management

  1. Rule-out complications:
  2. Steroids
    • Parenteral vs PO depending on severity
      • PO: prednisone 40mg x 2wks, then decrease by 5mg per week

Disposition

  • Admit for severe complication or severe flare requiring IV steroids

See Also

References

  1. ↑ Nguyen H, Loustaunau C, Facista A, Ramsey L, Hassounah N, Taylor H, et al. (July 2010). "Deficient Pms2, ERCC1, Ku86, CcOI in field defects during progression to colon cancer". Journal of Visualized Experiments (41). doi:10.3791/1931. PMC 3149991. PMID 20689513.
  2. ↑ 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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