Ulcerative colitis: Difference between revisions
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==Background== | ==Background== | ||
[[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>]] | |||
*Inflammation tends to be progressively more severe from proximal to distal colon | *Inflammation tends to be progressively more severe from proximal to distal colon | ||
*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== | ||
*Abdominal cramps and diarrhea (often bloody) | *[[abdominal pain|Abdominal cramps]] and [[diarrhea]] (often [[rectal bleeding|bloody]]) | ||
===Classification=== | ===Classification=== | ||
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**<4 bowel movements per day | **<4 bowel movements per day | ||
**No systemic symptoms | **No systemic symptoms | ||
**Few extraintestinal | **Few extraintestinal manifestations | ||
**Occasional constipation and rectal bleeding | **Occasional constipation and rectal bleeding | ||
*Moderate | *Moderate | ||
**Colitis extends to splenic flexure | **[[Colitis]] extends to splenic flexure | ||
*Severe | *Severe | ||
**Frequent BM | **Frequent BM | ||
**[[Anemia]] | **[[Anemia]] | ||
**[[Fever]] | **[[Fever]] | ||
** | **Weight loss | ||
**Frequent extraintestinal manifestations | **Frequent extraintestinal manifestations | ||
**Pancolitis | **[[colitis|Pancolitis]] | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Colitis types}} | {{Colitis types}} | ||
== | ==Evaluation== | ||
===Work-up=== | ===Work-up=== | ||
*CBC | *CBC | ||
*Chemistry | *Chemistry | ||
*LFTs/lipase | |||
*Consider: | |||
**ESR/CRP | |||
**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) | |||
**Type and screen (if significant bleeding) | |||
*Imaging | *Imaging | ||
**Consider CT based on clinical features | **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== | ==Management== | ||
#Rule-out complications: | #Rule-out complications: | ||
#*Hemorrhage | #*[[GI bleed|Hemorrhage]] | ||
#*Toxic megacolon | #*[[Toxic megacolon]] | ||
#**Develops in advanced disease when all the layers of the colon become involved | #**Develops in advanced disease when all the layers of the colon become involved | ||
#**Presentation | #**Presentation | ||
#***Severely ill | #***Severely ill | ||
#*** | #***Abdomen distended, tender, [[peritonitis]] | ||
#***Fever, tachycardia | #***[[Fever]], [[tachycardia]] | ||
#***Leukocytosis (may be masked if | #***[[Leukocytosis]] (may be masked if patient taking steroids) | ||
#**Perforation results in high mortality | #**Perforation results in high mortality | ||
#** | #**[[Abdominal x-ray]]: long, continuous segment of air-filled colon >6cm in diameter | ||
#*Perirectal fistula | #*[[anal fistula|Perirectal fistula]] | ||
#*Perirectal abscess | #*[[Anorectal abscess|Perirectal abscess]] | ||
#*Obstruction (due to stricture) | #*Obstruction (due to stricture) | ||
#*Carcinoma | #*[[colon cancer|Carcinoma]] | ||
#Steroids | #[[Steroids]] | ||
#*Parenteral vs PO depending on severity | #*Parenteral vs PO depending on severity | ||
#**PO: 40mg x 2wks, then decrease by 5mg per week | #**PO: [[prednisone]] 40mg x 2wks, then decrease by 5mg per week | ||
==Disposition== | ==Disposition== | ||
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
| 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
- 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
- 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
- ↑ 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.
- ↑ 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.