Medical Management of Ulcerative Colitis
7 results
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Benign Disease- A patient with ulcerative colitis refractory to medical therapy undergoes total proctocolectomy. Which extraintestinal manifestation is most likely to persist after the colectomy?
- A 55-year-old man presents with severe refractory ulcerative colitis. He was admitted to the hospital and placed on parenteral steroids. He is now receiving salvage therapy with infliximab, but is not responding. The best next step in management is to:
- A 43-year-old man is seen on an inpatient consultation basis for ulcerative colitis that has been recalcitrant to medical management for the past 2 weeks. He has worsening abdominal pain, persistent diarrhea, rectal bleeding, and intermittent fevers. He was given empiric broad-spectrum antibiotics for elevated leukocytosis. Colonoscopy revealed pancolitis consistent with findings of ulcerative colitis. Although his pain improves, he continues to have 15 to 20 watery bowel movements per day. What is the most appropriate next step in management?
- A 28-year-old man with a history of ulcerative colitis undergoes a total proctocolectomy with stapled ileal pouch–anal anastomosis. Six months after surgery, he presents with urgency, increased stool frequency, and bloody bowel movements. Endoscopic examination findings are shown (Figure A and B). What is the best next step in management?
- A 28-year-old woman presents with pan-ulcerative colitis since age 16 years. Her symptoms were previously well-controlled with vedolizumab and mesalamine, but she has recently begun to experience frequent flares of disease. She is interested in having children and is referred for consideration of elective surgery involving a restorative proctocolectomy with an ileal pouch–anal anastomosis. What is the postsurgical effect on future childbearing about which you would counsel the patient?
- A 76-year-old woman presents with a history of CHF to the hospital with abdominal pain of 24 hours’ duration and bloody diarrhea. Her temperature is 98.6°F (37.0°C), heart rate 90 beats/min, white blood cell count 16,000/mL (16´109/L), and blood pressure 110/70 mm Hg. Computed tomography imaging is ordered (Figure); Her abdomen is tender but without peritoneal signs. Colonoscopy shows patchy, superficial areas of ulceration and sloughing in the transverse colon. The best next treatment for this patient is which of the following?
- Perioperative