Internal Medicine

0521779407-21 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 18:59

Ulcerative Colitis 1477

ULCERATIVE COLITIS

CHRISTINE A. CARTWRIGHT, MD

history & physical

■History: bloody diarrhea, tenesmus, mucus, abdominal cramps,

fever

■Trigger factors: NSAIDs, antibiotics, smoking cessation, stress, ?OCP

■Physical signs: fever, tachycardia, abdominal tenderness, bloody

stools; extra-intestinal manifestations: peripheral arthritis, uveitis,

episcleritis, scleritis, erythema nodosum, pyoderma gangrenosum

tests

Basic Studies: Blood

■CBC, ESR, albumin, LFTs

Other Studies

■stool studies: culture, O+P×3, C. difficile× 3

■amebic ELISA serology

■colonoscopy and biopsies

differential diagnosis

■Crohn’s disease or other causes:

■Infectious colitis (amebiasis, pseudomembranous, CMV, shigella,

campylobacter, E. coli, salmonella)

■Ischemic colitis

■Radiation

■Drugs

■Cleansing agents

Differences between ulcerative colitis and Crohn’s disease:

➣ulcerative colitis: mucosal, diffuse, continuous, involves the rec-

tum, limited to colon

➣Crohn’s: transmural, patchy, skip lesions, discrete ulcers, can

occur anywhere in the GI tract but usually involves the distal

ileum and right colon and spares the rectum; perianal disease,

fistulae, abscesses, strictures, obstruction, granulomas

management

What to Do First

■Assess severity and extent

■Severity: