Severe ULCERATIVE Colitis Flashcards
(10 cards)
Treatment
1-Hospital admission with close monitoring. NPO if severe disease or clear liquid diet as
tolerated.
Treatment
2-Rule out complicated ulcerative colitis.
*Obtain an abdominal radiograph in all patients:
x Patients on chronic immunosuppression may have minimal symptoms and may not manifest the classic
physical findings of perforation. In patients with severe symptoms, consider cross sectional imaging
(CT) to assess the extent of colitis and to rule out perforation and abscess
Treatment
3-Rule out co-existing infection:
* Check stool C. difficile toxin. If positive, treat with vancomycin .
Treatment
4-Perform flexible sigmoidoscopy and biopsy to document the severity of inflammation and rule out
CMV infection with CMV immunohistochemistry.
Do not perform a full colonoscopy and minimize air insufflation to avoid perforation in severe ulcerative colitis.
Treatment
5-Low molecular weight heparin to avoid thromboembolism
Treatment
6-Start IV steroids with methylprednisolone at 40-60 mg once daily or hydrocortisone 100 mg three times daily
x In patients who respond to IV steroids change to oral prednisone 40 mg once daily, observe for 24 hours, then discharge on
that dose if stable.
Follow in clinic within 2 weeks. Taper steroids once the patient’s symptoms are controlled .
Treatment
7-Management of patients who do not respond to IV steroids (within 48-72 hours):
*Obtain early surgical consult to consider colectomy.
*Consider repeat flexible sigmoidoscopy to evaluate endoscopic response to treatment.
x Consider infliximab, cyclosporin, or surgery (colectomy).
Infliximab: 5 mg/kg IV at week 0, 2, 6, and then every 8 weeks
o Infliximab is an effective rescue therapy in patients who fail steroid treatment. It is associated with a lower rate of colectomy.
o Higher doses of infliximab and more intensive induction is not associated with higher efficacy.
Cyclosporin: 2-4 mg/kg/day IV
o This medication is associated with significant toxicity and requires blood level monitoring. It
should only be given by physicians experienced in prescribing cyclosporin.
o Side effects of cyclosporin include hypertension, electrolyte imbalance, seizures,
nephrotoxicity, and opportunistic infections.
*Assess response to cyclosporin and infliximab within 5-7 days
Role of biomarkers in ulcerative
Colitis
biomarkers have been developed to assess disease activity in ulcerative colitis and
potentially avoid endoscopy.
x Fecal calprotectin, fecal lactoferrin and serum CRP are the most widely used biomarkers.
x Threshold: Fecal calprotectin < 150 mcg/g, normal lactoferrin, normal CRP.
x If biomarkers are elevated, endoscopy should be performed to confirm active inflammation.
x Biomarker monitoring of patients in symptomatic active UC
x Moderate to severe symptoms: elevated biomarkers (fecal calprotectin >150 mcg/g, elevated
lactoferrin, elevated CRP) can rule in active inflammation and avoid endoscopy to confirm active inflammation. Empiric therapy and treatment adjustments can be given without endoscopy.
*Mild symptoms: In patients with elevated biomarkers suggests endoscopy for disease assessment.
*patients with normal biomarkers, disease assessment with endoscopy or repeat biomarker testing in 3-6
months.31 Since management is similar if biomarkers are elevated or normal, it is unclear if measuring
Criteria of severe ulcerative colitis
3,10,30 ,90
Albumin<3gm
Hb<10 gm
Esr >30
Motions >6 motions/day
Toxic megacolon in abdominal imaging
HR >90/minute
Temp>37.8
Blood in lumen in endoscopy
Role of biomarkers in ulcerative
Colitis
الخلاصة
* العيان اعراضه جامدة والماركرز عالية متعملش منظار
*. العيان اعراضه بسيطة والماركرز عالية اعمل منظار
