Colitis

First Things First (assess & treat for the following)

Toxic symptoms suggesting fulminant colitis
- Severe abdominal pain
- High fever
- Marked leukocytosis
- Altered mental status
- Hypotension
Colonic dilation suggesting toxic megacolon
- Obtain serial plain films or CT; >7 cm colonic diameter or “thumbprinting”
- Correct electrolyte abnormalities, especially hypokalemia.
- Eliminate possible exacerbating factors:
  - Opiates
  - Anticholinergics
  - Antidepressants
  - Antimotility agents
Peritoneal findings suggesting perforation
- Obtain immediate surgical consultation (if not already accomplished).
- Free perforation is absolute indication for surgery.
Infectious etiology
Other etiologies in differential diagnosis (ie, “look-alikes”)
- Ischemic colitis
- Colonic volvulus
- Diverticulitis
- Obstructing colon cancer

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