1 / 15

February 10, 2011

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

nanji
Download Presentation

February 10, 2011

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. February 10, 2011

  2. Toxic Megacolon Total or segmental nonobstructive colonic dilatation PLUS systemic toxicity Most commonly transverse colon

  3. Toxic Megacolon:Etiology • IBD • Infectious colitis • C. diff • Salmonella, shigella, campylobacter • CMV • Amoebic colitis • Ischemic colitis • Volvulus • Diverticulitis • Obstructive colon cancer

  4. Toxic Megacolon: Precipitating Factors Hypokalemia Antimotility agents Opiates Anticholinergics Antidepressants Barium enema Colonoscopy

  5. Clinical Manifestations Toxic appearing Altered sensorium Hypotension/tachycardia Fever Abd distension and tenderness +/- peritoneal signs

  6. 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

  7. 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

  8. 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

  9. Treatment • Broad spectrum abx • Third-generation cephalosporin • Metronidazole • Discontinue • Antimotility meds • Opiates • Anticholinergics • Generous IVF

  10. Surgery: Indications Perforation No improvement in 3 days

  11. Nutrition • TPN if needed • Resume enteral feedings with first signs of improvement • Mucosal healing • Motility

  12. C. Diff and Toxic Megacolon Stop offending agent Vancomycin PO Flagyl IV

More Related