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Toxic Megacolon

 Syn. Acute megacolon , Toxic dilatation of colon

Signs & Symptoms

 Abdominal distention
Ref: Uptodate [ Toxic megacolon] Harrison [ 1181]
Abdominal pain
Ref: Uptodate [ Toxic megacolon] Cecil [ 419]
Frequently Severe bloody diarrhea
Ref: Uptodate [ Acute colonic pseudo-obstruction (Ogilvie’s syndrome)] Cecil [ 419]
Abdominal tenderness
Ref: Uptodate [ Acute colonic pseudo-obstruction (Ogilvie’s syndrome)] Harrison [ 1181]

Physical Examination

 Abdominal distention
Ref: Uptodate [ Toxic megacolon] Harrison [ 1181]
Malaise
Ref: Uptodate [ Toxic megacolon]
Appear very ill
Ref: Uptodate [ Acute colonic pseudo-obstruction (Ogilvie’s syndrome)]

Lab / Serology

 Metabolic alkalosis
Note: secondary to volume depletion and potassium loss is associated with a poor prognosis
Ref: Uptodate [ Toxic megacolon]
Metabolic acidosis
Note: suggests the presence of ischemic colitis
Ref: Uptodate [ Toxic megacolon]
Hypoalbuminemia
Note: serum albumin concentration below 3 g/dL
Ref: Uptodate [ Toxic megacolon]

Imagin Study

 Radiograph reveal marked dilated colon
Note: with the greatest distention in the ascending and descending segments, transverse or right colon with a diameter of >6 cm
Ref: Harrison [ 1181] Cecil [ 419]
Radiographic evidence of colonic distension #Criteria
Ref: Uptodate [ Toxic megacolon]
Radiography reveal pneumoperitoneum #Perforation
Ref: Harrison [ 1181]

Complication

 Develop toxic dilatation
Note: 30 percent develop toxic dilatation within three months of diagnosis, and approximately 60 percent within the first three years
Ref: Uptodate [ Toxic megacolon]
Perforation #Perforation
Ref: Harrison [ 2264]

Risk Factors

 Ulcerative colitis
Ref: Epocrates [ https://online.epocrates.com/diseases/87932/Toxic-colitis-and-toxic-megacolon/Risk-Factors]
Crohn disease
Ref: Epocrates [ https://online.epocrates.com/diseases/87932/Toxic-colitis-and-toxic-megacolon/Risk-Factors]
HIV infection
Ref: Epocrates [ https://online.epocrates.com/diseases/87932/Toxic-colitis-and-toxic-megacolon/Risk-Factors]

Cause

 Due to infectious colitis
Ref: Uptodate [ Toxic megacolon]
Due to inflammatory bowel disease
Ref: Uptodate [ Toxic megacolon]

Other