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Figures
- Fig 1.
Management algorithm for acute severe colitis. AXR = abdominal X-ray; CDT = Clostridium difficile toxin; CRP = C-reactive protein; CT = computerised tomography; FBC = full blood count; G&S = group and save; IV = intravenous; LFT = liver function tests; MC&S = microscopy, culture and sensitivity; OD = once daily; s/c = subcutaneous; TPMT = thiopurine methyltransferase; U&E = urea and electrolytes.
Tables
- Table 1.
Classification of disease severity in ulcerative colitis. Adapted from Truelove and Witts' criteria.
Disease severity Characteristics Mild <4 stools/day +/− blood, normal ESR, no signs of toxicity Moderate 4–6 stools/day, occasional blood, minimal signs of toxicity, CRP ≤30 mg/L Severe ≥6 bloody stools/day AND any of: > temperature >37.8°C > tachycardia >90 bpm> > anaemia, Hb <105 g/L > ESR >30 mm/h, CRP >30 mg/L Fulminant 10 stools/day, continuous bleeding, toxicity, abdominal tenderness or distention, transfusion requirement, colonic dilatation on X-ray CRP = C-reative protein; ESR = erythrocyte sedimentation rate; Hb = haemoglobin.
Diagnosis Differentials Infectious colitis > Campylobacter spp > Salmonella > Escherichia coli 0157 > Shigella > Clostridium difficile > Cytomegalovirus-induced colitis in immunosuppressed patients > Chlamydia trachomatis (lymphogranuloma venereum) Inflammatory > Crohn's disease > Diverticulitis Vascular > Ischaemic colitis Iatrogenic > Drug-induced colitis, particularly non-steroidal anti-inflammatory drugs > Radiation protopathy
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Management of acute severe ulcerative colitis (NICE CG 166)
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