Pediatrics in Review
HOME HELP CONTACT US SUBSCRIPTIONS CME ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Rapid Responses: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Rapid Responses are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Mascarenhas, M. R.
Right arrow Articles by Altschuler, S. M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Mascarenhas, M. R.
Right arrow Articles by Altschuler, S. M.
Related Collections
Right arrow Gastrointestinal Disorders

(Pediatrics in Review. 1997;18:95-98.)
© 1997 American Academy of Pediatrics

Consultation with the Specialist: Treatment of Inflammatory Bowel Disease

Maria R. Mascarenhas, MD*
Steven M. Altschuler, MD{dagger}
* Attending Physician in Gastroenterology, The Children's Hospital of Philadelphia, PA.

{dagger} Chief, Division of Gastroenterology & Nutrition.
A previously well 16-year-old boy presents with a 1-week history of profuse bloody diarrhea, abdominal pain, fatigue, weight loss (5 lbs), and anorexia. The physical examination reveals pallor and a toxic appearance, a pulse of 130 beats/min, a temperature of 39.4°C (103°F), blood pressure of 90/60 mm Hg, and a respiratory rate of 20 breaths/min. The abdominal examination is significant for diffuse tenderness and distension and decreased bowel sounds. The rectal examination reveals an empty rectal vault; bright red mucus remains on the glove. Results of the laboratory examination include a hemoglobin count of 8 g/dL, a white blood cell count of 20,000/mm3 (neutrophils, 50%; bands, 20%; lymphocytes, 30%), and a serum albumin level of 3 g/dL. An abdominal radiograph shows a dilated transverse colon 5 cm in width, with thumbprinting in the descending colon.

This is the picture of a patient who has severe colitis with toxic megacolon. The differential diagnosis in such a patient includes severe infectious colitis, inflammatory bowel disease (IBD), and vasculitis (Table 1Go ).


View this table:
[in this window]
[in a new window]
  		Table 1. Differential Diagnosis of Colitis in an Adolescent

It sometimes is difficult to distinguish between acute infections and IBD and between Crohn disease (CD) and ulcerative colitis (UC) in the patient who presents with fulminant colitis. After stool samples have been sent for analysis, culture, and Clostridium toxin assay, therapy for fulminant colitis should be instituted. C difficile colitis can present with fulminant colitis and can precipitate a flare or disease exacerbation in a patient who has IBD.

Significant progress has been made in recent years in the management of IBD. The goals of therapy are to control the disease and induce a lasting remission; prevent relapses; and achieve normal nutrition, growth, and life-style. The treatment of IBD is pharmacological, nutritional, surgical, and psychosocial.


   Pharmacological Therapy
 
The goal of drug therapy is . . . [Full Text of this Article]






HOME HELP CONTACT US SUBSCRIPTIONS CME ARCHIVE SEARCH TABLE OF CONTENTS
Pediatrics Pediatrics in Review
Copyright © 1997 by the American Academy of Pediatrics.