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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.
IN a patient with BRBPR and hemo instability...what the next step in management ?
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
tx for UC with mild proctitis?
- 1. Topical tx with 5ASA compounds ( mesalamine suppository )
- 2. Taper over 4-6 weeks
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
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
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.
with UC when do you begin surveillance colonoscopy?
8-10 years after dx