Inflammatory bowel disease (ulcerative colitis): Clinical sciences
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Inflammatory bowel disease, or IBD, is a condition characterized by chronic gastrointestinal tract inflammation. It can be subdivided into Ulcerative Colitis and Crohn Disease.
Ulcerative Colitis, or UC, primarily affects the colon and is characterized by continuous ulcerations of the mucosa and submucosa, which may lead to abdominal pain, bloody diarrhea, and tenesmus. Management is based on the severity of disease and they can be categorized as mild to moderate, moderate to severe, or acute severe.
Now, when assessing an individual with suspected ulcerative colitis, you should first perform an ABCDE assessment to determine if they are stable or unstable. Unstable individuals might present with signs of shock, like tachycardia and hypotension, so you might have to secure their airway, breathing, and circulation before further workup. Unstable patients may also have signs of complications like toxic megacolon, perforated colon, or severe refractory hemorrhage. These patients should be hospitalized, and given intravenous fluids and antibiotics.
Once they are stable, you should find out what caused the instability. If the patient presents with pallor and profuse rectal bleeding, consider anemia and hypovolemic shock due to severe refractory hemorrhage. In this situation, begin systemic corticosteroids and transfuse blood products. If the abdomen is distended or firm, consider toxic megacolon. An X-ray might reveal an enlarged colon and possibly signs of perforation, like pneumoperitoneum.
These patients should also have stool studies to rule out C. difficile infection. A high yield fact to keep in mind about unstable patients is that you should avoid colonoscopy because there is a high risk of colon perforation. If an unstable patient has evidence of severe refractory hemorrhage, toxic megacolon, or perforated viscus, you can consult surgery for possible colectomy.
Now, when it comes to stable individuals, the first step is to obtain a focused history and physical exam. History typically reveals diffuse or periumbilical crampy abdominal pain, bloody diarrhea, tenesmus, and fecal urgency. Some patients report extra-intestinal symptoms, like eye pain, joint pain, and rashes.
Sources
- "A Review of Four Practice Guidelines of Inflammatory Bowel Disease" Cureus (2021)
- "AGA Clinical Practice Guidelines on the Management of Moderate to Severe Ulcerative Colitis" Gastroenterology (2020)
- "ACG Clinical Guideline: Ulcerative Colitis in Adults" American Journal of Gastroenterology (2019)
- " I have a patient with unintentional weight loss. How do I determine the cause?" Symptom to Diagnosis an Evidence Based Guide (2020)
- "Diarrhea" CDIM Core Medicine Clerkship Curriculum Guide, 4th ed (2020)
- "AGA Clinical Practice Guidelines on the Management of Mild-to-Moderate Ulcerative Colitis" Gastroenterology (2019)
- "The global, regional, and national burden of inflammatory bowel disease in 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017" Lancet Gastroenterol Hepatol (2020)