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Dysphagia
Coeliac diagnosis pathway (Adults)
Sengstaken/Minnesota Tube for Bleeding Varices
Eradication of Helicobacter pylori
Acute Severe Ulcerative Colitis
Acute Upper GI Bleeding (AUGIB)
Iron Deficiency Anaemia
Dyspepsia
Nutritional Support in Adults
Refeeding Syndrome
Parenteral Nutrition
Crohn’s Disease
Acute Pancreatitis
Suspected Variceal Bleeding
Lower Gastrointestinal Bleeding
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Acute Severe Ulcerative Colitis
Last updated 10th October 2024
Initial Management
- Contact [email protected] if inpatient advice required from Gastroenterology Team.
- Patient to be referred to IBD MDT (meets every Thursday) – Please complete – Gastroenterology IBD MDT referral form
Criteria for Diagnosis
- ≥6 bloody stools/day and systemic toxicity with at least one of: –
- temp >37.8
- HR >90/min
- Hb <105g/l
- CRP >30
Consider Other Causes of Bloody Diarrhoea
- Bacterial infection (Clostridium difficile; Campylobacter; Salmonella; Shigella; E Coli 0157)
- Viral infection (whether immunocompromised)
- Diverticular disease (diverticulitis)
- Ischaemic colitis
- Crohn’s disease
- Amoebiasis (? history of travel)
Initial investigations
- Daily FBC, U&E, LFTs, serum albumin, glucose, CRP
- Additional bloods on admission – calcium, phosphate, magnesium,haematinics (iron, B12 and folate)
- Urgent stool culture and C diff Toxin – minimum of 4 stool samples required to detect 90% cases.
- Stool chart for frequency, consistency, blood and volume
- Abdominal Xray to exclude colonic dilatation – toxic megacolon if colon >5.5cm or caecum >9cm
- Flexible sigmoidoscopy and biopsy within 24 hours of admission, with histology by 5 days to confirm diagnosis and exclude CMV
Acute Severe Ulcerative Colitis Pathway
Maintenance of Remission
- Patients with UC should normally receive maintenance therapy with aminosalicylates, azathioprine or mercaptopurine to reduce risk of relapse
- Oral Mesalazine 2.4g bd is recommended as first line therapy
- Topical Mesalazine 1g daily may be used in distal disease ± oral mesalazaine though patients less likely to be compliant
- Long term treatment with steroids is unacceptable – consider steroid sparing medication (Thiopurines, AntiTNF) if becoming steroid dependent
Surgery for Acute Severe Ulcerative Colitis
- 20-30% patients will ultimately require surgery
- The operation of choice for acute severe colitis failing to respond to intensive medical treament is subtotal colectomy, end ileostomy and preservation of a long rectal stump
- Failure to heal and sepsis are common in patients on high doses of steroids, but if these can be avoided/dealt with then surgery is curative
Risk of Colonic Carcinoma
- Patients with extensive colitis (extending proximal to splenic flexure) are at risk
- Surveillance colonoscopies recommended yearly, 3 yearly or 5 yearly according to degree of risk – increased if family history colon cancer or presence of primary sclerosing cholangitis
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Content updated by Dr Zahra Bayaty