• Differential of Bloody Diarrhea
  • Shigella
  • Shiga toxin producing E. coli (EHEC), E. coli O157:H7
  • IBD Flare
  
  

  Posted 10/25/16 09:03:05 AM by Ying Liu

• Indicators of UC Disease Severity (Truelove Witts Table)
  • Number of stools per day
  • Temperature, HR, Clinical signs (abdominal pain)
  • Elevated ESR/CRP
  • Hemoglobin/Enamia
  • Radiographic imaging showing bowel edema/dilation
  • Extra-intestinal Markers of Disease that increase with flare include uveitis (not iritis), big joint disease (not small or AS), Erythema Nodosum (not pyoderma)
  
  

  Posted 10/25/16 09:04:57 AM by Ying Liu

• Infection in UC
  • High rates of C. Diff given mucosal breakdown; can also precipitate IBD flare
    • C. Diff Stool PCR has high sensitivity (90%) and Specificity (96%) and good PPV and NPV 
  • Treat empirically with PO Vancomycin, metronidazole has less utility
  • Also cover empirically with Cipro/Flagyl
  
  

  Posted 10/25/16 09:07:54 AM by Ying Liu

• Induction Therapy for Severe/Fulminant UC (in addition to steroids)
  • First-line is Infliximab (5-10mg/kg) at 0,2, and 6 weeks then maintenance therapy
  • 2nd-line is Cyclosporine A but Cochrane review is equivocal and no good bridge therapy after induction
  • Vedolizumab (integrin inhibitor, blocks leukocyte trafficking into GI mucosa) is a possibility but only approved for moderate disease
  
  

  Posted 10/25/16 09:11:21 AM by Ying Liu

• Indications for Colectomy 
  • Colonic Perforation
  • Massive GI bleeding
  • Toxic Megacolon
  • Acute Fulminant Colitis refractory to medical treatment 
  NOTE: Would scope and biopsy prior to surgery to confirm diagnosis as preferred surgery for UC is J-pouch to preserve rectal function, but this surgery is terrible for Crohn's. This is one instance where serologies have utility.
  
  
  
  
  

  Posted 10/25/16 09:13:59 AM by Ying Liu

• Miscellaneous
  • UC associated with PBC; can pick this up with elevated alkphos but not in acute setting
  • Proctitis does not affect CRC risk
  • Currently, no genetic screening recommendations for UC
  
  

  Posted 10/25/16 09:14:59 AM by Ying Liu

Created by Christopher Kelly

Know a hypochondriac? Get them the best-selling book 'AM I DYING?!: A Complete Guide to Your Symptoms, and What to Do Next'
The information on the website does not constitute official guidelines except where explicitly stated.
It is not meant to replace the advice of a health professional.