1 / 14

Ulcerative colitis

Ulcerative colitis. Essentials of diagnosis: Bloody diarrhea Lower abdominal cramps & fecal urgency Anemia, low serum albumin Negative stool cultures Sigmoidoscopy is the key to diagnosis. Ulcerative colitis: Assessment of disease severity.

mervyn
Télécharger la présentation

Ulcerative colitis

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Ulcerative colitis

  2. Essentials of diagnosis: • Bloody diarrhea • Lower abdominal cramps & fecal urgency • Anemia, low serum albumin • Negative stool cultures • Sigmoidoscopy is the key to diagnosis

  3. Ulcerative colitis: Assessment of disease severity

  4. Stomach Jejunum Ileum Colon    Sulfasalazine Olsalazine Meslamine pH sensitive Release Tablets Mesalamine Delayed Release Capsules 5-ASA derivatives in ulcerative colitis: site of absorption of major drugs

  5. Treatment of ulcerative colitis: • Proctitis: • Mesalamine suppositories, 500mg twice daily, or • Hydrocortisone foam, 90mg per rectum daily or • Hydrocortisone suppositories, 100mg per rectum daily • Proctosigmoiditis: • Meslamine enema, 4g per rectum daily, or • Hydrocortisone enema, 100mg per rectum daily

  6. Treatment of ulcerative colitis: • Extensive colitis: • Mild to moderate: • Sulfasalazine, 1.5-3g orally twice daily., or • Mesalamine tablets (delayed release), 2.4-4.8g/day, or • Balsalszide,2.25g three times a day • If no response after 2-4 weeks, add prednisone,20-40mg/d (taper by 5mg/week) • Severe: • Methylprednisolone, 48-60mg IV daily

  7. Distal colitis: • Drug of choice meslamine suppositoryIf patients fail to respond: • Increase the same topical agent twice daily • Combination treatment with a 5-ASA enema at bed-time and a corticosteroid enema or foam in the morning. • Combination of a topical agent with oral 5-ASA agent

  8. Distal colitis: • Early/ frequent relapse: • Maintenance- mesalamine supposositories (500mg/d) • -Oral 5-ASA agents

  9. Mild to moderate colitis: • 5-ASA derivatives • Sulfasalazine 500mg bd (along with folic acid 1mg/d) • Mesalamine 1g four times daily • Balsalazide 2.25g tid • Olsalazine 500mg bd • No improvement after 2-3 weeks: • Topical steroids • 5-ASA enemas • Oral steroids

  10. Severe colitis: • General: • Discontinue oral intake for 24-48hrs. • Total parenteral nutrition • Correct acid-base deficits,anemia • Treat C difficle infection if present.

  11. Severe colitis: • Steroids: • Methylprednisolone 48-64mg or hydrocortisone 300mg in 4 divided doses or continuous infusion • Can try ACTH infusion 120 units/24hr. • Cyclosporine IV 2-4mg/kg/d infusion • SURGICAL

  12. Fulminant colitis and toxic megacolon: • Broad spectrum antibiotics to cover anaerobes & Gram –ve bacteria • Surgery to prevent perforation • Maintanence of remission: • Chronic sulfasalazine, olsalazine, mesalamine.

  13. Refractory disease: • Mercaptopurine • Azathioprine • Transdermal nicotine • Infliximab

More Related