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home - Colon - Miscellaneous - Toxic Megacolon Written by Dr Sebastian Zeki
Methods GMP
Knows the physiology of intestinal absorption, secretion and motility SCE 1
Understands the biochemical processes occurring within the gut
lumen and at mucosal level

Has awareness of the factors controlling these processes – in
particular the neuro-endocrine influences

Understands the range of mechanisms by which diarrhoea can result
from disturbances in each of these processes

Knows the causes of both acute and chronic diarrhoea
Knows the range of investigations appropriate to determining the
cause of the patient’s diarrhoea and is aware of the range of
therapeutic possibilities

Makes a detailed clinical assessment of patients that present with
either acute or chronic diarrhoea

Recognises the potential need for urgent fluid replacement CbD,
Makes appropriate use of microbiology and other relevant laboratories in reaching a diagnosis

Shows ability to interpret results, reach a diagnosis and formulate a
treatment plan

Reacts appropriately to the urgency of the clinical presentation
Always shows sympathy and understanding especially when the
patient is distressed

Toxic Megacolon

Radiology: Aetiologies:IBD.Infectious colitides of diverse aetiology.Ischaemic colitis.Volvulus.Diverticulitis.Obstructive colon cancer.CMV infection (AIDS patients). The muscle fibers are frequently shortened and rounded with aggregates of eosinophilic cytoplasm. Preserved submucosal and myenteric plexi is usual and evidence against a neuro-pathic process. Inflammation throughout colonic wall Pathogenesis factors:The release of inflammatory mediators.Bacterial infiltration.Increased iNOS and generation of excessive nitric oxide.Colonic dilatation. OutcomeMortality is 27% without and 19% with surgery.70% of cases of toxic megacolon treated medi-cally do not require a colectomy later. Toxic megacolonEvidence of SIRS/ Inc WCC and colonic distention on X-ray Treatments:Insertion of a Ryles tube to decompress GI tract.Discontinue all antimotility agents, opiates, and anticholinergics.Broad spectrum antibiotics.Consider steroids as can decrease iNOS.Consider steroids in preg-nancy with fulminant colitis.Consider surgery (subtotal colectomy with end ileostomy) if 48-72 hours of colonic distention. Associated with depth of inflammation and ulceration. Lab resultsThese are consistent with inflammation.Hypokalaemia due to colonic fluid loss and subsequent metabolic alkalosis can occur. X-ray -Transverse or Right colon more dilated 6cm or more -Lost haustral pattern -May see ulceration as air filled projections Written by Dr Sebastian Zeki