Ulcerative colitis: Difference between revisions
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== Background == | ==Background== | ||
*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 | ||
==Clinical Features== | ==Clinical Features== | ||
| Line 25: | Line 23: | ||
**Pancolitis | **Pancolitis | ||
== Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Colitis types}} | {{Colitis types}} | ||
== Diagnosis == | ==Diagnosis== | ||
===Work-up=== | |||
*CBC | |||
*Chemistry | |||
*Imaging | *Imaging | ||
** | **Consider CT based on clinical features | ||
== | ==Management== | ||
#Rule-out complications: | #Rule-out complications: | ||
#*Hemorrhage | #*Hemorrhage | ||
| Line 43: | Line 40: | ||
#**Presentation | #**Presentation | ||
#***Severely ill | #***Severely ill | ||
#***Abd distended, tender, | #***Abd distended, tender, peritonitis | ||
#***Fever, tachycardia | #***Fever, tachycardia | ||
#***Leukocytosis (may be masked if pt taking steroids) | #***Leukocytosis (may be masked if pt taking steroids) | ||
| Line 56: | Line 53: | ||
#**PO: 40mg x 2wks, then decrease by 5mg per week | #**PO: 40mg x 2wks, then decrease by 5mg per week | ||
== Disposition == | ==Disposition== | ||
*Admit for severe complication or severe flare requiring IV steroids | *Admit for severe complication or severe flare requiring IV steroids | ||
== See Also == | ==See Also== | ||
*[[Colitis]] | *[[Colitis]] | ||
== | ==References== | ||
<references/> | |||
[[Category:GI]] | [[Category:GI]] | ||
Revision as of 10:14, 21 February 2016
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)
Classification
- Mild
- <4 bowel movements per day
- No systemic symptoms
- Few extraintestinal manifestaions
- Occasional constipation and rectal bleeding
- Moderate
- Colitis extends to splenic flexure
- Severe
Differential Diagnosis
Colitis
- Infectious colitis
- Ischemic colitis
- Ulcerative colitis
- CMV colitis
- Crohn's colitis
- Toxic colitis (antineoplastic agents)
- Pseudomembranous colitis
- Fibrosing colonopathy (Cystic fibrosis)
Diagnosis
Work-up
- CBC
- Chemistry
- 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
- Abd distended, tender, peritonitis
- 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
- Steroids
- Parenteral vs PO depending on severity
- PO: 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