2. Bloody diarrhea ≥ 6 motions/ day
Pulse ≥ 90 bpm
Body temperature ≥ 37.8 C
Hemoglobin ≤ 10.5 g/dl
ESR ≥ 30 mm/hr
3. Role of Colonoscopy
Full colonoscopy should NOT be made due to
risk of perforation instead flexible endoscopy
may be indicated to assess severity.
4. Management
• Hospital admission for IV fluids and electrolyte
replacement.
• DVT and pulmonary embolism prophylaxis
• IV antibiotics ONLY in patients with high grade
fever, leukocytosis and megacolon.
• Enteral nutrition is preferred (NPO in
fulminant colitis)
5. Initial therapy
• Methylprednisolone 20 mg IV every 8 hrs for 1
week.
• High dose oral 5-ASA (Pentaza 4.8 gm daily)
• 5-ASA / steroids enemas and suppository
6. Maintenance therapy
• Patients who respond to IV glucocorticoids
should be converted to equivalent dose of oral
steroids
• Oral steroids tapered after 2- 4 weeks
• Rectal 5- ASA / Steroids can be tapered over 2
– 4 months
• Oral 5- ASA should be continued at the same
dose.
7. If he patient did not achieve remission (≤ 3
motions a day) by day 3 consider using second
line therapy: Azathioprine or Infliximab.
8. COLECTOMY
• For patients having 4- 8 motions with blood
and CRP ≥ 45 mg/L or motions ≥ 8 without
blood, the likelihood for later colectomy
during the same admission was 85%.
• Total colectomy with ileostomy with
preservation of the rectum is advised for a
later restorative procedure.
