Findings suggestive of sever Ulcerative colitis :

Pulse  more than 100 bpm

Fever of more than 38 C.

Albumin of less than 30 g/L

CRP more than 45 mg/L.

Bowels open 9 – 10 times during the first 24 hours.

Abdominal X ray shows : Toxic megacolon , mucosal islands and dilated small bowel on radiograph.

MANAGEMENT :

Provide initial resuscitation

ABC / Airway , Breathing and circulation.

INFECTIVE COLITIS :

This should be considered in all cases of acute colitis.

If the patient is very ill and infection cannot be excluded ,it is safer to treat emoerically with combination of antibiotics such as ciprofloxacin and Metronidazole.

This will cover most potential pathogens such as Amoebae and Clostridium difficile.

PSEUDOMEMBRANOUS ENTEROCOLITIS :

This is usually seen inprolonged use of antibiotics espcisally third generation Cephalosporins.

It should be treated with Metronidazole ( iv or PO ) or vancomycin PO after sigmoidoscopy and rectal biopsy has been performed.

And stool has been sent for C. difficile toxin.

INFLAMMATORY BOWEL DISEASE:

A moderate or severe exacerbation should be treated with systemic steroids eg Methylprednisolone 80 – 120 mg intravenously given in to divided doses.

Less severe exacerbations eg those limited to the rectum  should be masnaged with rectsal steroid preparation  with or without smaller dose of oral or intravenous steroids.

5 ASA / Aminosalicylic acid products  also have a role in acute attack.

In patients with known IBD , early involvement of colorectal surgical; team is important.

Don’t wait till evidence of GI perforation or toxic megacolon becomes apparent.