sleisenger textbook of gastroenterology pdf free download

Systemic antibiotics often are empirically administered, because mortality from toxic megacolon correlates with the development of sepsis. Medical management for toxic megacolon is directed at treating the underlying inflammation, restoring colonic motility, and preventing free colonic perforation. Often a very limited insertion will suffice to gauge the mucosal appearance and, if necessary, to allow a biopsy to be done. 371 When performing diagnostic procedures such as colonoscopy in these patients great care must be used not to overdistend the colon and not to exert pressure along the walls of the thinned co colon. Precipitating factors for toxic megacolon have been reported to include electrolyte imbalance (particularly hypokalemia), use of antimotility drugs including anticholinergic agents and narcotics.

Loss of contractility from the inflammatory reaction leads to the accumulation of gas and fluid within the lumen and subsequent colonic dilatation.

This complication of UC results from extension of colonic inflammation beyond the mucosa to the underlying tissues, including the muscularis propria. 370 It occurs in approximately 5% of severe flares of UC.

Toxic megacolon is defined as acute colonic dilatation with a transverse colon diameter of more than 6 cm (on radiologic examination) and loss of haustration in a patient with a severe attack of colitis ( Fig. Mark Feldman MD, in Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 2021 Toxic Megacolon

Sleisenger textbook of gastroenterology pdf free download