GASTROENTEROLOGY ARTICLE OF THE WEEK
May 10, 2007
Caprilli R, Viscido A, Latella G. Current management of severe ulcerative colitis. Nature Clin Pact Gastroenterol Hepatol 2007;4:92-101
1. Laboratory findings that may predict a fatal outcome with toxic megacolon include
a. metabolic alkalosis
b. hyperchloremia
c. hypokalemia
d. hypocalcemia
e. high serum bicarbonate
True or False
2. The diagnosis of toxic megacolon in a patient with severe ulcerative colitis is made when the transverse colon diameter exceeds 5.5 cm on plain X-ray
3. Someone should tell the Italians that “ciclosporin” has a “y” in English
4. Small bowel distention in a patient with severe ulcerative colitis places the patient at increased risk of toxic megacolon.
5. Severe ulcerative colitis usually causes a metabolic acidosis
6. Most people who require cyclosporine to improve will relapse, the use of azathioprine at discharge may decrease the relapse rate
7. The lack of marked improvement in a patient with severe ulcerative colitis after 5 days of IV steroids, NPO, and IV antibiotics is a clear indication for colectomy
8. If a patient with severe UC responds to cyclosporine, the cyclosporine should be continued po for 3 to 6 months.
9. Cyclosporine and/or infliximab are usually contraindicated in patients with toxic megacolon
10. The use of cyclosporine decreases the number of patients who require a colectomy
11. Infliximab use in patients with severe UC decreases the risk for colectomy
12. Surgery is mandatory for patients with toxic megacolon in whom the colon remains dilated after 48-72 hours of IV steroids, antibiotics and electrolyte replacement