Toxic Megacolon
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TOXIC MEGACOLON 1.
CHIEF COMPLAINT
2.
HPI
3.
ROS
4.
SYMPTOMS •Toxic megacolon •Diarrhea •Abdominal pain •Rectal bleeding •Tenesmus •Vomiting •Fever
5.
HISTORY
•FAMILY HISTORY a. Diabetes b. Hypertension •SOCIAL HISTORY •PAST MEDICAL HISTORY a. Ulcerative colitis b. Pseudomembranous colitis c. Inflammatory bowel disease d. Infectious colitis e. Radiation colitis f. Ischemic colitis g. Nonspecific colitis secondary to chemotherapy •SURGICAL HISTORY •CHRONIC CONDITIONS a. Ulcerative colitis b. Inflammatory bowel disease 6.
ALLERGIES
7.
PHYSICAL EXAMINATION •Tachycardia •Hypotensive •Tachypneic
•Abdomen distended •Bowel sounds decreased •Rebound tenderness •Abdominal rigidity 8.
SPECIFIC DATA LIKE GRADING
9.
TESTS TO BE ORDERED •CBP •Chemistry panel •Serum electrolytes •Nutritional and coagulation panel •C-reactive protein •Plain abdominal radiographs •CT scan •Endoscopy •Flexible sigmoidoscopy •Colonoscopy
10. ASSESSMENT/PLAN •Reduce colonic distension to prevent perforation •Correct fluid and electrolyte disturbances •Treat toxemia and precipitating factors. •Fluid replacement •Electrolyte repletion and transfusion should be aggressive.
Surgical Care •a total proctocolectomy •subtotal colectomy 11. EDUCATION 12. MEDICATION •Hydrocortisone •Methylprednisolone •Cyclosporine •Ampicillin •Gentamicin •Metronidazole
13. FOLLOW UP
CHIEF COMPLAINT
2.
HPI
3.
ROS
4.
SYMPTOMS •Toxic megacolon •Diarrhea •Abdominal pain •Rectal bleeding •Tenesmus •Vomiting •Fever
5.
HISTORY
•FAMILY HISTORY a. Diabetes b. Hypertension •SOCIAL HISTORY •PAST MEDICAL HISTORY a. Ulcerative colitis b. Pseudomembranous colitis c. Inflammatory bowel disease d. Infectious colitis e. Radiation colitis f. Ischemic colitis g. Nonspecific colitis secondary to chemotherapy •SURGICAL HISTORY •CHRONIC CONDITIONS a. Ulcerative colitis b. Inflammatory bowel disease 6.
ALLERGIES
7.
PHYSICAL EXAMINATION •Tachycardia •Hypotensive •Tachypneic
•Abdomen distended •Bowel sounds decreased •Rebound tenderness •Abdominal rigidity 8.
SPECIFIC DATA LIKE GRADING
9.
TESTS TO BE ORDERED •CBP •Chemistry panel •Serum electrolytes •Nutritional and coagulation panel •C-reactive protein •Plain abdominal radiographs •CT scan •Endoscopy •Flexible sigmoidoscopy •Colonoscopy
10. ASSESSMENT/PLAN •Reduce colonic distension to prevent perforation •Correct fluid and electrolyte disturbances •Treat toxemia and precipitating factors. •Fluid replacement •Electrolyte repletion and transfusion should be aggressive.
Surgical Care •a total proctocolectomy •subtotal colectomy 11. EDUCATION 12. MEDICATION •Hydrocortisone •Methylprednisolone •Cyclosporine •Ampicillin •Gentamicin •Metronidazole
13. FOLLOW UP
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