جمعه مباركه Managment Guideline for hospitalized acute seve | Clinical Medicine

جمعه مباركه

Managment Guideline for hospitalized acute severe UC

مريض ال Sever Ulcerative colitis هيجي بالاعراض التاليه :

●Bloody stool frequency ≥6 per day

●PLUS at least one of the following characteristics (ie, evidence of systemic toxicity):

•Fever (temperature ≥37.8 degrees C)

•Tachycardia (heart rate ≥90 beats/minute)

•Anemia (hemoglobin <10.5 g/dL [105 g/L])

•Elevated inflammatory marker (eg, C-reactive protein, erythrocyte sedimentation rate)

في قواعد عامة لأي مريض Sever Ulcerative Colitis ...

Test for C. difficile infection ( CDI)

ولو طلع المريض عنده CDI بنستخدمله ال Oral Vancomycin

Avoid NSAIDs drug & anticholinergic drug

Avoid Narcotics

لانها بتقلل ال GI motality وبتزود فرصه ال Sepsis ..

Don't Give TPN Unless patient can't tolerate Oral feeding

Give Anticoagulant

مريض ال Sever Acute UC بيكون عنده Hypercoagulopathy
فبنعطى Heparin او LMWH ك Prophylaxis

AGAINST broad spectrum antibiotics unless there's Indication for using it as pneumonia or other Infection

ال Broad spectrum Antibiotics بيزود ال Risk لل
C.difficile

كيف بنعالج مريض ال Sever Acute UC ...

بشكل عام اغلب ال Guideline اتفقو انه بدايه ال Induction تكون ب Steroid ولو ما صار Response خلال 3 ايام بيتشفت المريض على Infliximab او Cyclosporin بجرعه 2mg/kg IV وبتتقسم الجرعه لمرتين في اليوم ..

Induction therapy for hospitalized acute severe UC..


1st line : Start with methylprednisolone 60 mg/d or hydrocortisone mg / 6 h 100

2ed line : if steroid FAILED assessed after 3day switch to salvage medical therapy (cyclosporin or infliximab) or colectomy

3ed Line : Failed cyclosporin or infliximab after 4-7day
Do total or subtotal colectomy with end ileostomy.




Maintenance therapy for hospitalized acute severe UC :

TORONTO 2015

لو المريض اخد Infliximab في ال Induction هيكمل فيه ك maintenance بالاضافه لل Thiopurine
اما لو المريض مشى ع Cyclosporin ك Induction
فبيمشي ع Cyclosporin orally وبعدها يكمل ع Thiopurine
جرعه ال Cyclosporin orally بتكون ضعف جرعه ال I.V اللي مشى عليها المريض خلال ال Induction ...

During Using Cyclosporine Prophylaxis against Pneumocystis pneumonia is required


ACG 2019

If steroid used in induction use thiopurines as azathioprine

If Infliximab used in nduction continue infliximab

If Cyclosporine used in induction shift to thiopurines or vedolizumab




في مجموعه من المرضى ممنوع يستخدمو ال Cyclosporine

we do not use cyclosporine in patients with any of the following conditions:

●Hypertension (blood pressure >140/90 mmHg).

●Renal disease (serum creatinine >1.4 mg/dL [124 microm/L]).

●History of seizure disorders.

●Low serum total cholesterol (<120 mg/dL [3.11 mmol/L]).

●Low serum magnesium level.

●Low serum albumin (<2.3 g/dL [23 g/L]) [34].

●Prior intolerance or failure of immunomodulator therapy (eg, azathioprine).

●Prior failure of biologic agent (eg, infliximab)

●Inability to comply with dosing and monitoring requirements while on cyclosporine.

وهيك بنكون خلصنا ال Ulcerative colitis management ورح نبدأ ان شاء الله بال Crohns Disease Management Guideline

#لعلي_أفيدك