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