By ULY CLINIC
Inflammatory Bowel Diseases
Introduction
Inflammatory bowel disease (IBD) is an idiopathic disease involving an immune reaction of the body to its own intestinal tract. The 2 major types of IBD are ulcerative colitis (UC) and Crohn disease (CD).
Pathologically, ulcerative colitis is limited to the colon while Crohn disease can involve any segment of the gastrointestinal (GI) tract from the mouth to the anus.
Ulcerative Colitis (UC)
Introduction
Inflammatory condition that involves the rectum and extends proximally to affect a variable extent of the colon up to the caecum
Diagnostic Criteria
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Diarrhoea
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Rectal bleeding
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Tenesmus, passage of mucus
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Crampy abdominal pain
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Fevers and chills PLUS
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Endoscopic evidence of diffuse and continuous colonic mucosal inflammation with friability and loss of mucosal vascularity. characteristic cobble stone appearance AND
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Histologic evidence of abnormal crypt architecture and superficial inflammation typical of UC.
Pharmacological Treatment
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Sulphasalazine (PO) 1000mg four times a day for acute disease, reducing to 1000mg once daily for maintenance
OR
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Mesalazine (PO) 1.5g–4g/day in divided and reduced to 0.75–2g g/day in divided doses for maintenance PLUS
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Prednisolone (PO) 30–60mg once daily for severe, acute and extensive disease; tapering gradually after induction of remission.
Note
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Complication of UC may present with massive haemorrhage, toxic mega colon, AND perforation with features of peritonitis.
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Correction of fluid deficit and/or blood is important in acute severe forms which may necessitates hospitalization
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Lifelong follow up is required due to risk of bowel cancer Use steroids only when the disease is confirmed and for induction of remission only.
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Refer to next level of care with adequate expertise and facilities for all suspected cases for initial evaluation and management and cases presenting with acute complications
Updated on, 2.11.2020
References
1. STG