Management of Severe Ulcerative Colitis

Management of Severe Ulcerative Colitis - Flowchart Management of Severe Ulcerative Colitis Management of Severe Ulcerative Colitis

Flowchart

Management of severe ulcerative colitis

End

^* Assessing response to treatment:

Stools >6/day
CRP >50
Systemic features - abdominal pain, fever, tachycardia, anorexia

^* Assessing response to treatment:

Stools >6/day
CRP >50
Systemic features - abdominal pain, fever, tachycardia, anorexia

^* Assessing response to treatment:

Stools >6/day
CRP >50
Systemic features - abdominal pain, fever, tachycardia, anorexia

At presentation:
Stop opioids, NSAIDS, anti-diarrhoeal medications
LMWH prophylaxis and anti-embolism stockings
Hydrocortisone 100 mg 6-hourly IV
5 ASAs for example mesalazine
Consider antibiotics for example metronidazole

After 72 hours^*

After 72 hours^* ^* ^*

Responding well:
Change to PO steroids
Consider Azathioprine/6MP
Discharge with outpatient follow up

Responding well

Poor response or worsening:
Repeat AXR
Consider repeat sigmoidoscopy
Involve colorectal surgeon

Poor response or worsening

Consider colectomy

Consider ciclosporin or Infliximab

Evidence of toxic dilatation
Patient systemically unwell

Yes

No response^*

^* ^*