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Questions 1–20
Published in Anna Kowalewski, SBAs and EMQs in Surgery for Medical Students, 2021
This is a classic presentation of ulcerative colitis. Remember this is a relapsing and remitting disease that always involves the rectum and spreads proximally. It can also involve the terminal ileum via backwash ileitis. There is an association with non- smokers. Fifteen per cent develop extensive disease and 20% develop pancolitis.
Clostridium difficile and Its Mimics in the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
With C. difficile pancolitis, the aim of therapy is two-fold. First, the drug(s) used should have a high degree of anti-C. difficile activity. Second, these antibodies should achieve therapeutic colon wall levels. High intraluminal levels are of no benefit in a transmural colon wall process. Third, pancolitis is often accompanied by microscopic translocation of colon flora from the wall into the peritoneum, i.e., causing microscopic peritonitis. Furthermore, pancolitis may result in colon perforation or toxic megacolon/perforation [31].
Inflammatory bowel disease
Published in Michael JG Farthing, Anne B Ballinger, Drug Therapy for Gastrointestinal and Liver Diseases, 2019
Elizabeth Carty, Anne B Ballinger
Ulcerative colitis (UC) always begins in the rectum and extends proximally to affect a variable extent of the colon. Mucosal inflammation is in a circumferential and uninterrupted pattern, although patients using topical therapy may have apparent rectal sparing. At the time of diagnosis, disease is confined to the rectum (proctitis) or rectum and sigmoid (proctosigmoiditis) in 27-44% of patients. The frequency of total colonic involvement (pancolitis) varies but is generally present in less than one-third of patients (Fig. 5.1).4, 5 The disease may progress proximally with time in patients who are initially diagnosed as having disease limited to the distal colon. For instance, with disease confined to the rectum or rectosigmoid, extension to the proximal colon occurs in 10-30% of patients after 10 years. Most patients with UC experience a chronic, relapsing, remitting course and will require maintenance treatment in order to reduce the number of relapses.
Tissue factor in ulcerative colitis, with and without concomitant primary sclerosing cholangitis
Published in Upsala Journal of Medical Sciences, 2019
Johan Vessby, Maria Lampinen, Mikael Åberg, Fredrik Rorsman, Agneta Siegbahn, Alkwin Wanders, Marie Carlson
Study participants (UC, n = 23; PSC-UC, n = 24; controls, n = 11) were recruited in connection to elective colonoscopy at the Department of Gastroenterology, Uppsala University Hospital, Uppsala, Sweden, between December 2011 and October 2015. All (non-PSC) UC patients included in the study had a medical history of pancolitis. In all PSC cases, the IBD was classified as UC. The IBD diagnoses were based on established clinical, endoscopical, and histological criteria (17). PSC patients were previously diagnosed based on the presence of typical biochemistry, cholangiographic findings, and/or histological abnormalities (18). Exclusion criteria were recent treatment with corticosteroids (within last 4 weeks), ongoing biological medication, or previous liver transplant. No patient had a history of thromboembolic events. Control subjects were patients without inflammatory bowel disease or colorectal neoplasia. PSC-UC subjects were younger than controls (p = 0.03), and the same tendency was found in the UC group (p = 0.06). There was no statistical difference between the number of patients on 5-aminosalicylic acid/sulphasalazine or immunomodulators (IM, azathioprine and mercaptopurine) between UC and PSC-UC. As expected, the hepatobiliary marker alkaline phosphatase (ALP) was higher in PSC-UC than both UC and controls (not shown). The levels of other investigated inflammatory markers were comparable between the groups. Relevant clinical characteristics are presented in Table 1.
Inflammatory bowel disease in patients over the age of 70 y. Does the disease duration influence its behavior?
Published in Scandinavian Journal of Gastroenterology, 2018
Jose M. Huguet, Marisa Iborra, Marta Maia Bosca-Watts, Nuria Maroto, Rafael Gil, Xavier Cortes, David Hervás, Jose M. Paredes
Most patients studied were diagnosed between 60 and 70 y of age. The mean age at diagnosis was 63.4 y (SD 12.6 y), and the median age was 65 y. Thus, 69% of the patients (229/331) were younger than 70 years old at diagnosis, with the remaining patients (31%) being diagnosed at age 70 y or older. The mean duration of the disease was 13.4 y (SD 11.74 y and median 10.7 y). Forty-seven percent (149) were women, and the mean age at the time of the study was 77.34 y (±5.39). Ten patients (3.2%) had inflammatory bowel disease unclassified, 180 (57.3%) had Ulcerative colitis (UC) and 124 (39.5%) had Crohn's disease (CD). There was a similar proportion between pancolitis and distal colitis with a proximal progression of 1.9%. The demographic characteristics of patients are presented in Table 1.
Catastrophic antiphospholipid syndrome in a patient with systemic sclerosis and hereditary angioedema: case report and literature review
Published in Modern Rheumatology Case Reports, 2018
Jean Liew, Marcia Friedman, Sima Desai, Lindsay Taute, Nastaran Neishaboori, Peter Stenzel, Ajay Wanchu
On admission, she was afebrile, tachycardic, and hypotensive. Significant labs included leucocytosis (27 × 109 per L), serum creatinine of 2.96 mg/dL (prior baseline, 0.4–0.5 mg/dL), and serum lactate of 6.6 mg/dL. In the first 36 hours of admission, the acute kidney injury and lactic acidosis resolved with intravenous fluids and empiric broad spectrum antibiotics. However, she developed progressive thrombocytopenia, with platelet count declining from 299 × 109 per L to a nadir of 25 × 109 per L, and anaemia, with haemoglobin declining from 13.9 g/dL to 6.3 g/dL. On hospital day 4, she developed purpura on her hands and feet (Figure 1). Computed tomography (CT) of the abdomen and pelvis demonstrated pancolitis. Given the uncertainty of her case as well as the concern for thrombotic thrombocytopenic purpura (TTP), she was transferred to our facility on hospital day 5.