Ulcerative colitis: Difference between revisions
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==Background== | == Background == | ||
*Inflammation tends to be progressively more severe from proximal to distal colon | |||
*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== | == Diagnosis == | ||
*Abdominal cramps and diarrhea (often bloody) | |||
*Classification | *Abdominal cramps and diarrhea (often bloody) | ||
**Mild | *Classification | ||
*** | **Mild | ||
***No systemic symptoms | ***<4 BM/d | ||
***Few extraintestinal manifestaions | ***No systemic symptoms | ||
***Occasional constipation and rectal bleeding | ***Few extraintestinal manifestaions | ||
**Moderate | ***Occasional constipation and rectal bleeding | ||
***Colitis extends to splenic flexure | **Moderate | ||
**Severe | ***Colitis extends to splenic flexure | ||
***Frequent BM | **Severe | ||
***Anemia | ***Frequent BM | ||
***Fever | ***Anemia | ||
***Wt loss | ***Fever | ||
***Frequent extraintestinal manifestations | ***Wt loss | ||
***Frequent extraintestinal manifestations | |||
***Pancolitis | ***Pancolitis | ||
==Work-Up== | == Work-Up == | ||
*Labs | |||
**CBC | *Labs | ||
**Chemistry | **CBC | ||
*Imaging | **Chemistry | ||
**?Abd x-ray | *Imaging | ||
**?Abd x-ray | |||
**?CT A/P | **?CT A/P | ||
==DDx== | == DDx == | ||
#Infectious colitis | |||
#Crohn's colitis | #Infectious colitis | ||
#Ischemic colitis | #Crohn's colitis | ||
#Toxic colitis (antineoplastic agents) | #Ischemic colitis | ||
#Pseudomembranous colitis | #Toxic colitis (antineoplastic agents) | ||
#Pseudomembranous colitis | |||
#Gonococcal proctitis | #Gonococcal proctitis | ||
==Treatment== | == Treatment == | ||
*Rule-out complications | |||
**Hemorrhage | *Rule-out complications | ||
**Toxic megacolon | **Hemorrhage | ||
***Develops in advanced disease when all the layers of the colon become involved | **Toxic megacolon | ||
***Presentation | ***Develops in advanced disease when all the layers of the colon become involved | ||
****Severely ill | ***Presentation | ||
****Abd distended, tender, peritonitic | ****Severely ill | ||
****Fever, tachycardia | ****Abd distended, tender, peritonitic | ||
****Leukocytosis (may be masked if pt taking steroids) | ****Fever, tachycardia | ||
***Perforation results in high mortality | ****Leukocytosis (may be masked if pt taking steroids) | ||
***Abd x-ray: Long, continuous segment of air-filled colon | ***Perforation results in high mortality | ||
**Perirectal fistula | ***Abd x-ray: Long, continuous segment of air-filled colon >6cm in diameter | ||
**Perirectal abscess | **Perirectal fistula | ||
**Obstruction (due to stricture) | **Perirectal abscess | ||
**Carcinoma | **Obstruction (due to stricture) | ||
**Carcinoma | |||
*Prednisone Taper: 40mg x 2 weeks, then decrease by 5mg per week. | |||
== Disposition == | |||
== | == See Also == | ||
== | == Source == | ||
Tintinalli | |||
Tintinalli | |||
[[Category:GI]] | [[Category:GI]] | ||
Revision as of 05:43, 16 August 2012
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
Diagnosis
- 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
- Mild
Work-Up
- Labs
- CBC
- Chemistry
- Imaging
- ?Abd x-ray
- ?CT A/P
DDx
- Infectious colitis
- Crohn's colitis
- Ischemic colitis
- Toxic colitis (antineoplastic agents)
- Pseudomembranous colitis
- Gonococcal proctitis
Treatment
- 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, peritonitic
- Fever, tachycardia
- Leukocytosis (may be masked if pt 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
- Prednisone Taper: 40mg x 2 weeks, then decrease by 5mg per week.
Disposition
See Also
Source
Tintinalli