Toxic megacolon medical therapy
Jump to navigation
Jump to search
|
Toxic Megacolon Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Toxic megacolon medical therapy On the Web |
|
American Roentgen Ray Society Images of Toxic megacolon medical therapy |
|
Risk calculators and risk factors for Toxic megacolon medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Farima Kahe M.D. [2]
Overview
Medical therapy of toxic megacolon include stablizing the patient, decompression and medications. Medications for toxic megacolon include corticosteroids, immunosuppresants and antibiotics.
Medical Therapy
Medical therapy of Toxic megacolon include:[1][2][3][4][5][6]
- 1. General considerations
- 1.1. Complete bowel rest
- 1.2. Intravenous fluid support
- 1.3. Electrocytes monitoring and correction of abnormalities
- 1.4. Withdrawal of all anticholinergics, antidiarrheal and narcotics
- 1.5. Rule out infectious etiology
- 2. Decompression
- 2.1. Rectal tube
- 2.2. Nasogastric or long naso-intestinal tube
- Note: Long intestinal tubes are considered to be more effective than naso-gastric tubes in colonic decompression but should be placed into the ileum under fluoroscopic guidance.
- Note: Maneuver 1: Asking patients to roll into the prone position for 10-15 minutes every 2-3 hours and encourage them to pass gas.
- Note: Maneuver 2: Turning to the prone knee-elbow position, which moves the rectum to the highest point in the body.
- 3. Medical management
- 3.1. Toxic megacolon associated with inflammatory bowel disease(IBD):[1][9]
- 3.1.1. Corticosteroids:
- Preferred regimen (1): Hydrocortisone 100 mg IV q6h
- Preferred regimen (2): Methylprednisolone 60 mg IV q24h
- 3.1.2. Immunosuppresants:
- Preferred regimen (1): Cyclosporin 2 mg/kg q24h for 7 days
- Note: Maintain serum levels between 150 to 250 ng/mL
- Preferred regimen (2): Infliximab 5 mg/kg for 3 to 7 days
- 3.1.1. Corticosteroids:
- 3.2. Toxic megacolon associated with Clostridium difficile [10]
- Preferred regimen (1): Vancomycin 500 mg PO q6h or via a naso-gastric tube AND Metronidazole 500 mg IV q8h
- 3.1. Toxic megacolon associated with inflammatory bowel disease(IBD):[1][9]
References
- ↑ 1.0 1.1 Gan, S. Ian; Beck, P. L. (2003). "A new look at toxic megacolon: an update and review of incidence, etiology, pathogenesis, and management". The American Journal of Gastroenterology. 98 (11): 2363–2371. doi:10.1111/j.1572-0241.2003.07696.x. ISSN 0002-9270.
- ↑ Autenrieth DM, Baumgart DC (2012). "Toxic megacolon". Inflamm. Bowel Dis. 18 (3): 584–91. doi:10.1002/ibd.21847. PMID 22009735.
- ↑ Farkouh E, Wassef R, Allard M, Atlas H (1983). "Toxic megacolon in inflammatory colon disease". Union Med Can (in French). 112 (11): 1014–6. PMID 6665937.
- ↑ Gonzáles Lara V, Pérez Calle JL, Marín Jiménez I (2003). "Approach to toxic megacolon". Rev Esp Enferm Dig. 95 (6): 422–8, 415–21. PMID 12918536.
- ↑ Koudahl G, Kristensen M (1975). "Toxic megacolon in ulcerative colitis". Scand. J. Gastroenterol. 10 (4): 417–21. PMID 1153934.
- ↑ Meyers S, Janowitz HD (1978). "The place of steroids in the therapy of toxic megacolon". Gastroenterology. 75 (4): 729–31. PMID 213344.
- ↑ Present DH, Wolfson D, Gelernt IM, Rubin PH, Bauer J, Chapman ML (1988). "Medical decompression of toxic megacolon by "rolling". A new technique of decompression with favorable long-term follow-up". J. Clin. Gastroenterol. 10 (5): 485–90. PMID 3183326.
- ↑ Panos MZ, Wood MJ, Asquith P (1993). "Toxic megacolon: the knee-elbow position relieves bowel distension". Gut. 34 (12): 1726–7. PMC 1374472. PMID 8282262.
- ↑ Strong SA (2010). "Management of acute colitis and toxic megacolon". Clin Colon Rectal Surg. 23 (4): 274–84. doi:10.1055/s-0030-1268254. PMC 3134807. PMID 22131898.
- ↑ Bolton RP, Culshaw MA (1986). "Faecal metronidazole concentrations during oral and intravenous therapy for antibiotic associated colitis due to Clostridium difficile". Gut. 27 (10): 1169–72. PMC 1433873. PMID 3781329.