-
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