Bright red blood per rectum case 3

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Author:
Anonymous
ID:
279666
Filename:
Bright red blood per rectum case 3
Updated:
2014-07-25 22:00:43
Tags:
Ulcerative colitis
Folders:
Medicine
Description:
Bright red blood per rectum case 3
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  1. Bright per blood per rectum ddx?
    1. UC< Chrons, Diverticulosis, angiodysplasia, hemmoroids, anal fissure, infectious colitis, ischemic colitis, colonic polyps, cancer, brisk upper GI bleed.
  2. IN a patient with BRBPR and hemo instability...what the next step in management ?
    resuscitation
  3. is suspecting UC? what do you next?
    confirm via Flex sigmoidoscopy or colonoscopy along with RECTAL BX. 

    other order to rule our other etiologies --> CBC, CMP. ESR,  and stool studies
  4. tx for UC with mild proctitis?
    • 1. Topical tx with 5ASA compounds ( mesalamine suppository )
    • 2. Taper over 4-6 weeks
  5. tx for UC with mod proctitis?
    • 1. Oral tx with % ASA 
    • 2. Folic Acid supplementation for patients taking sulfsalazine 
    • 3. Steroids are added when 5 ASA compounds fail to induce remission. 
    • 4. Steroids should not be used for maintenance of remission
    • 5. immunomoduators ( azathioprine , 6 MP ) for refractory cases
  6. UC and managing diarrhea/cramps/mood?
    • 1. antidiarrheal agents like loperamide 
    • - but avoid this in severe proctitis
    • 2. anticholernergic for tummy cramps
    • 3. antidepressants /anxiolytics
  7. severe protitis with UC?
    • 1. Hospitilize . resuscitate, IV fluids and lytes
    • 2. NPO. TPN
    • 3. Abd XR
    • 4. IV Steroids
    • 5. is fever , leukocytosis, or sepsis...antibiotics
    • 6. consider surgery for refractory cases.
  8. with UC when do you begin surveillance colonoscopy?
    8-10 years after dx

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