Colitis
Acute Colitis
Guidance
NICE: Ulcerative colitis: NG130. 2019 1
Treating acute severe ulcerative colitis: all extents of disease
The multidisciplinary team.
1.2.15 For people admitted to hospital with acute severe ulcerative colitis: Ensure that a gastroenterologist and a colorectal surgeon collaborate to provide treatment and management. inter alia ...
Assessing likelihood of needing surgery.
1.2.22 Assess and document on admission, and then daily, the likelihood of needing surgery for people admitted to hospital with acute severe ulcerative colitis. [2013]
1.2.23 Be aware that there may be an increased likelihood of needing surgery for people with any of the following:
- stool frequency more than 8 per day
- pyrexia
- tachycardia
- an abdominal X‑ray showing colonic dilatation
- low albumin, low haemoglobin, high platelet count or C‑reactive protein above 45 mg/litre (bear in mind that normal values may be different in pregnant women). [2013]
NB: No mention of CT. Only mention of AXR.
Truelove & Witts' Severity Index (1955) Severity assessment in ADULTS.
| Mild | Moderate | Severe | |
|---|---|---|---|
| Bowel movements per day | < 4 | 4 - 6 | >6 plus feature(s) of systemic upset |
| Blood in stools | Nil or Small | Mild to Severe | Visible blood |
| Fever (>37.8) | No | No | Yes |
| HR > 90 | No | No | Yes |
| Anaemia | No | No | Yes |
| ESR | <=30 | <=30 | > 30 |
| > Systemic upset is Fever, Tachy, Anaemia, ESR. |
Paediatric Ulcerative Colitis Index "PUCAI" (2006)
| Item | Points | |
|---|---|---|
| 1 | Abdominal Pain | |
| No Pain | 0 | |
| Ignorable Pain | 5 | |
| No ignorable Pain | 10 | |
| 2 | PR Bleeding | |
| None | 0 | |
| Small volume, in <50% of stools | 10 | |
| Small volume, in >50% of stools | 20 | |
| Large amounts (>50% of stool) | 30 | |
| 3 | Stool Consistency of most stools | |
| Formed | 0 | |
| Partially formed | 5 | |
| Completely unformed | 10 | |
| 4 | Number of stools per 24h | |
| 0-2 | 0 | |
| 3-5 | 5 | |
| 6-8 | 10 | |
| >8 | 15 | |
| 5 | Nocturnal Stools (any wakening) | |
| No | 0 | |
| Yes | 10 | |
| 6 | Activity Level | |
| No limitation | 0 | |
| Occasional Limitation | 5 | |
| Severe restriction | 10 | |
| Sum (0 - 85 ) |
Severity defined as : Severe : 65 + Moderate: 34-64 Mild: 10-34 Remission (disease not active): Below 10
Chronic Colitis
[TODO]
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https://www.nice.org.uk/guidance/ng130/chapter/Recommendations#treating-acute-severe-ulcerative-colitis-all-extents-of-disease (NICE 2019) ↩