Risk factors for developing C. Diff associated diarrhea:

The pathogenesis of C. diff infection:

Treatment for C. diff associated diarrhea:

Two criteria necessary to distinguish toxic megacolon from other types of colonic distention:

• Total or segmental non-obstructive colonic dilation
• Systemic toxicity (not present in other forms of megacolon)

Causes of toxic megacolon:

• Inflammatory
• Infectious
• Other (volvulus, obstructive colon cancer, etc.)

Diagnosis of toxic megacolon:

1) Radiographic evidence

2) Main Criteria (need 3):

• Fever
• Tachycardia
• Leukocytosis
• Anemia

3) Minor Criteria (need 1):

• Dehydration
• Altered level of consiousness
• Electrolyte imbalances
• Hypotension

* The overall clinical condition is more important than the absolute width of the dilated segment

Treatment of toxic megacolon:

• Initial therapy is medical, which is successful in preventing surgery in up to 50% of patients
• Specific medical therapies are aimed at the underlying etiology (i.e. steroids in IBD)

In patient’s with toxic megacolon due to C. diff colitis:

• Stop any offending antibiotics
• Start C. diff treatment: PO vancomycin 500 mg QID and IV metronidazole 500 mg Q8H
• Colectomy in patient’s who fail to improve within 48 – 72 hours or show evidence localized perforation