First Things First (assess & treat for the following)
- Toxic symptoms suggesting fulminant colitis
- Severe abdominal pain
- High fever
- Marked leukocytosis
- Altered mental status
- 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:
- 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
- Obstructing colon cancer
There's more to see -- the rest of this topic is available only to subscribers.