total or segmental nonobstructive colonic dilatation plus systemic toxicity most commonly...
TRANSCRIPT
February 10, 2011
Toxic Megacolon Total or segmental nonobstructive
colonic dilatation PLUS systemic toxicity Most commonly transverse colon
Toxic Megacolon:Etiology IBD Infectious colitis
• C. diff• Salmonella, shigella, campylobacter• CMV• Amoebic colitis
Ischemic colitis Volvulus Diverticulitis Obstructive colon cancer
Toxic Megacolon: Precipitating Factors
Hypokalemia Antimotility agents Opiates Anticholinergics Antidepressants Barium enema Colonoscopy
Clinical Manifestations Toxic appearing Altered sensorium Hypotension/tachycardia Fever Abd distension and tenderness +/- peritoneal signs
Diagnosis Radiographic colonic distention PLUS 3 of following
• Fever>38• Tachycardia• Leukocytosis• Anemia
PLUS at least 1 of the following• Dehydration• Altered sensorium• Electrolyte disturbances• Hypotension
Treatment Goal: reduce severity of colitis
• Restore normal motility• Decrease likelihood of perforation
Medical therapy is successful in preventing surgery in 50%
Surgical team should be consulted
Treatment Complete bowel rest NG tube ICU monitoring Serial abdominal exams CBC, lytes, KUB q 12 Appropriate treatment if IBD present
• Steroids Avoid steroids for infectious etiology
Treatment Broad spectrum abx
• Third-generation cephalosporin• Metronidazole
Discontinue • Antimotility meds• Opiates• Anticholinergics
Generous IVF
Surgery: Indications Perforation No improvement in 3 days
Nutrition TPN if needed Resume enteral feedings with first
signs of improvement• Mucosal healing• Motility
C. Diff and Toxic Megacolon
Stop offending agent Vancomycin PO Flagyl IV