Ulcerative colitis diagnosis

Suggested Alternatives for Differential Diagnosis Amebiasis, cholera, salmonellosis, schisto-mosis, yersiniosis, Clostridium difficile colitis, colon cancer, Crohn s disease, ulcerative colitis. 

The diagnosis is made by appropriate combinations of colonoscopy, biopsy and contrast radiology. Disease has to be differentiated from ulcerative colitis (see above) and from infective disease, notably tuberculosis and amoebiasis as well as diverticular disease and cancer. 

Enterocolitis, usually sparing the rectosigmoid, has been described in some cases (21). This type of flucytosine toxicity may be associated with deamination of flucytosine to 5-fluorouracil in the gut (1). Potentially fatal ulcerative colitis has been suspected in a few patients however, in most cases there were no diagnostic data to back up the diagnosis. 

The causal connection between NSAIDs and large bowel inflammation needs to be confirmed by appropriate epidemiological studies. Many publications have associated NSAID and colonic inflammation (SEDA-10, 77) (SEDA-15, 95), but the differential diagnosis between colonic inflammation arising de novo and exacerbation of underlying inflammatory bowel disease can be difficult, and the role of NSAIDs in aggravating ulcerative colitis or Crohn s disease or other inflammatory bowel disease is controversial (SEDA-10, 76) (SEDA-15, 95). A case-control study showed no association between appendi-cectomy for acute appendicitis and the use of NSAIDs (SEDA-22, 111). 

Monsen V, Sorstad J, Hellers G, et al. Extracolonic diagnosis in ulcerative colitis An epidemiologic study. Am J Gastroenterol 1990 85 711— 716. 

FIGURE 36-2. Recommendations for treating chronic diarrhea. Follow these steps (1) Perform a careful history and physical examination. (2) The possible causes of chronic diarrhea are many. These can be classified into intestinal infections (bacterial or protozoal), inflammatory disease (Crohn s disease or ulcerative colitis), malabsorption (lactose intolerance), secretory hormonal tumor (intestinal carcinoid tumor or VIPoma), drug (antacid), factitious (laxative abuse), or motility disturbance (diabetes mellitus, irritable bowel syndrome, or hyperthyroidism). (3) If the diagnosis is uncertain, selected appropriate diagnostic studies should be ordered. (4) Once diagnosed, treatment is planned for the underlying cause with symptomatic antidiarrheal therapy. (5) If no specific cause can be identified, symptomatic therapy is prescribed. 

Differential Diagnosis Between Ulcerative Colitis, Crohrfs Disease and Other Inflammatory Diseases 79... 

The role of abdominal ultrasound (US) has been less extensively investigated in ulcerative colitis (UC) than in Crohn s disease (CD). This is due to the different features between these two intestinal diseases. In fact, in UC, unlike in CD, inflammatory lesions are confined to the colon, have a predictable spread involving mainly the rectum, which is considered difficult to image by transabdominal US, and affects only the inner wall layer of the colon. Therefore, endoscopy is considered the method of choice in the diagnosis and in assessing extent and severity of the disease. 

Table 8.2. Main ultrasonographic features in differential diagnosis between ulcerative colitis and Crohn s disease...

Limberg B (1989) Diagnosis of acute ulcerative colitis and colonic Crohn s disease by colonic sonography. J Clin Ultrasound 17 25-31... 

Limberg B, Osswald B (1994) Diagnosis and differential diagnosis of ulcerative colitis and Crohn s disease by hydrocolonic sonography. Am J Gastroenterol 89 1051-1057... 

MDCT-E is not used for the diagnosis or staging of ulcerative colitis. Even when radiologic findings are present, they are often non-specific (Horton et al. 2000). Because of the sensitivity of CT enterography for Crohn disease, the principal role of this modality in patients with suspected ulcerative colitis is to help exclude findings of Crohn disease such as small bowel inflammation. 

A 38-year-old man with ulcerative colitis who had taken mesalazine for many years was switched to balsalazide 2.25 g tds and prednisolone 15 mg/day. However, 14 days later, while his bowel symptoms were improving, he developed intermittent chest pain (not typical of ischemia or pericarditis). Cardiac troponin I and C reactive protein were raised and there was widespread T wave inversion. Echocardiography showed apical and posterior segment wall motion abnormality with no effusion. A diagnosis of myocarditis was made, and balsalazide was withdrawn. His cardiac symptoms resolved within 48 hours. 

A 22-year-old man with ulcerative colitis was started on therapy with both oral (1.6 g, twice daily) and rectal (2 g, at bedtime) mesalazine. After 20 days, the patient developed fever, chest pain and dyspnoea. Laboratory tests revealed leukocytosis, with elevation of inflammatory indexes and cardiac troponin 1. Electrocardiogram displayed sinus tachycardia, inverted T-waves in inferior and left precordial leads. Echocardiography showed a mildly dilated left ventricle, diffuse hypokinesis and mild mitral regurgitation without pericardial effusion. A diagnosis of acute myocarditis was made and mesalazine was discontinued. Cardiac symptoms improved within few days. About... 

Dicyclomine hydrochloride behaves both as an antimuscarinic and a nonspecific antispasmodic agent. It is frequently employed in the treatment of irritable colon, spastic colitis, mucous colitis, spastic constipation and biliary dyskinesia. It also finds its use in the diagnosis of peptic ulcer by delaying gastric emptying process. 

Ischaemic colitis After 19 weeks of treatment with pegylated IFNa-2a and ribavirin for chronic hepatitis C genotype lb, a 48-year-old woman developed severe abdominal pain with haematochezia. CT, colonoscopy and colonic mucosal biopsy led to a diagnosis of ischaemic colitis. After discontinuation of the IFN-ribavirin therapy, the symptoms subsided and mucosal ulceration improved. A munber of cases of ischaemic colihs during IFN therapy have been reported, all of which involve the descending colon [46 ]. 

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