Advertisement

Ulcerative Colitis

  • Kristen T. Crowell
  • Evangelos MessarisEmail author
Chapter

Abstract

Ulcerative colitis (UC) is suspected in patients with chronic abdominal pain, bloody diarrhea, and rectal urgency or tenesmus. UC only affects the colon and characteristically starts in the rectum and extends proximally in a contiguous manner. Stool cultures should be sent in all patients on initial presentation to investigate for secondary infections. Patients presenting acutely should undergo a flexible sigmoidoscopy for diagnosis and a CT scan to evaluate the extent of colonic inflammation. If systemic toxicity or peritonitis is present, IV steroids and cyclosporine or infliximab are initiated. Failure of medical therapy or perforation is managed surgically by a total abdominal colectomy. Colonoscopy is used to diagnose stable patients. Medical therapy in the stable patient includes 5-ASA/mesalamine, PO steroids, and anti-TNF agents. Definitive treatment of UC is total abdominal colectomy with end ileostomy or ileal pouch-anal anastomosis.

Keywords

Chronic abdominal pain Bloody diarrhea Total abdominal colectomy Ileal pouch-anal anastomosis Anti-TNF agents Ulcerative colitis Colonoscopy C. difficile colitis CMV colitis 

References

  1. 1.
    Rao SS, Holdsworth CD, Read NW. Symptoms and stool patterns in patients with ulcerative colitis. Gut. 1988;29(3):342–5.CrossRefGoogle Scholar
  2. 2.
    Kornbluth A, Sachar DB, Practice Parameters Committee of the American College of Gastroenterology. Ulcerative colitis practice guidelines in adults: American College of Gastroenterology, Practice Parameters Committee. Am J Gastroenterol. 2010;105(3):501–23; quiz 524.CrossRefGoogle Scholar
  3. 3.
    Tariverdian M, Leowardi C, Hinz U, Welsch T, Schmidt J, Kienle P. Quality of life after restorative proctocolectomy for ulcerative colitis: preoperative status and long-term results. Inflamm Bowel Dis. 2007;13(10):1228–35.CrossRefGoogle Scholar
  4. 4.
    Aratari A, Papi C, Clemente V, Moretti A, Luchetti R, Koch M, et al. Colectomy rate in acute severe ulcerative colitis in the infliximab era. Dig Liver Dis. 2008;40(10):821–6.CrossRefGoogle Scholar
  5. 5.
    Dignass A, Eliakim R, Magro F, Maaser C, Chowers Y, Geboes K, et al. Second European evidence-based consensus on the diagnosis and management of ulcerative colitis part 1: definitions and diagnosis. J Crohns Colitis. 2012;6(10):965–90.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of SurgeryPenn State Milton S. Hershey Medical CenterHersheyUSA
  2. 2.Division of Colon and Rectal SurgeryBeth Israel Medical Center, Harvard Medical CenterBostonUSA

Personalised recommendations