Ulcerative colitis

We discussed a case of a middle aged woman who presented with acute on chronic abdominal pain, bloody diarrhea, tenesmus, found to have a new diagnosis of ulcerative colitis.

Clinical manifestations

  • Abdominal pain, weight loss, diarrhea, urgency, incontinence, tenesmus
  • Ask about characteristics of stool (frequency and presence of blood)
  • Ask about GI infectious exposures

Important initial workup

  • R/o infection (C diff, enteric pathogen panel, CMV)
  • Stool calprotectin
  • Inflammatory markers (e.g. CRP)
  • Can consider imaging to r/o toxic megacolon / serious complications if pretest probability is high

Important daily interventions

  • Pts with active IBD or exacerbations are at high risk of DVTs. Start DVT prophylaxis (LMWH, unfractionated heparin, fondaparinux)
  • Mechanical DVT prophylaxis if there is severe GI bleeding (e.g. hypotension / shock)

Treatment (main categories)

  • 5-ASA (e.g. mesalamine)
  • Glucocorticoids
  • Immunomodulators (e.g. azathioprine)
  • Biologics (e.g. infliximab)
  • Surgery

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