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Ulcerative Colitis

Topical 5-ASA. AND/OR. Oral 5-ASA. OR. Topical steroid. Ulcerative Colitis. Consider in all patients. exsanguination hemorrhages frank perforation carcinoma. YES. Surgery. DEXA scan bisphosphonate calcium/VitD. Criteria for Evaluating the Severity of

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Ulcerative Colitis

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  1. Topical 5-ASA AND/OR Oral 5-ASA OR Topical steroid Ulcerative Colitis Consider in all patients • exsanguination • hemorrhages • frank perforation • carcinoma YES Surgery • DEXA scan • bisphosphonate • calcium/VitD Criteria for Evaluating the Severity of Ulcerative Colitis (Truelove & Witts) Mild-Moderate Distal Colitis Mild-Moderate Extensive Colitis Severe Colitis R/O C.difficile Oral 5-ASA + Topical 5-ASA Glucocorticoids (IV methylprednisone) Remission NO YES Response & steroid sparing Response after 7-10 days Remission Maintenance Glucocorticoids (PO prednisone) NO YES Taper steroids + infliximab IV Cyclosporine + Azathioprine Maintenance (Azathioprine) NO YES YES NO Failure Failure Failure Failure Oral steroids (prednisone) Maintenance (5-ASA) + infliximab Surgery +Azathioprine or 6-MP Recurrent Symptoms? (steroid dependent)

  2. Mild ModerateSevere Bowel Movements <4 per day 4–6 per day >6 per day Blood in Small Moderate Severe stool Fever None <37.5°C mean >37.5°C mean Tachycardia None <90 mean pulse >90 mean pulse Anemia Mild >75% < 75% Sedimentation <30 mm >30 mm rate Truelove SC, Witts LJ. Cortisone in ulcerative colitis: Final report on a therapeutic trial. BMJ 1955;2:1041-8

  3. Topical steroids hydrocortisone • Cortifoam or • Cortenema, Colocort • Topical 5-ASA • Rowasa • Canasa AND/OR • Oral 5-ASA • sulfasalazine • Azulfidine • mesalamine • Lialda • Dipentum • Colazide • Asacol

  4. Anti-TNF α infliximab adalimumab (Crohn’s only)

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