ULCERATIVE COLITIS

1
ULCERATIVE COLITIS

• Presentation Dr.Doaa AL-Masri.
• Attendance Dr.Yousef Abu-Osbaa.
• Discussion Dr.Hisham Al-Nazer.

2
History

• Mohammad is 5 years old male patient, who was
  referred from the West Bank as a case of
  ulcerative colitis for further evaluation.

3
History

• At 4 months of age, he had large amount of watery
  diarrhea 4-6 times/day mixed with mucous and
  blood, with occasional vomiting.
• He was managed as cows milk protein allergy
  without improvement for the next 5 months.

4
History

• At 9 months of age, ulcerative colitis was
  diagnosed by colonoscopy.
• Treated with Prednisone, Sulfasalazine and
  Multivitamins, with no improvement.
• Diarrhea continued with exacerbation by
  infections, associated with poor weight gain and
  loss of appetite.
• He was referred to Jordan Hospital for further
  evaluation.

5
History

• Vaccination up to age.
• Nutritional history
• Breast fed till the age of 2 years.
• Semisolid food was introduced at the age of 6
  months .
• Now he eats regular food but with poor appetite.

6
History

• Development history appropriate for age.
• Family history unremarkable.
• Social history unremarkable.

7
Physical examination

• The patient looked ill, pale,wasted, not
  jaundiced.
• Normal vital signs.
• Weight 12.5 kg ( 3 standard deviation below the
  mean) .
• Length 92cm ( 4 standard deviation below the
  mean).

8
Physical examination

• Head Neck No oral ulcers.
• Chest Good air entry bilaterally. No added
  sounds.
• Heart Normal S1, S2. No murmur .
• Abdomen soft, and lax. No tenderness. No
  palpable organs.
• Normal male genitalia.
• Anal orifice normal.
• CNS Grossly intact.
• Lower limbs Muscle wasting.

9
Investigations

• Hb. 9.4 gm/dl
• PCV 30.4 gm/dl.
• MCV 61fl- MCH 19 pg MCHC30.9 g/dl
• WBC 23.9/L
• - Neutrophil 40.- Lymphocyte44
• -Monocyte 4. - Eosinophil 2.
• Blood film Neutrophils showed left shift

10
Investigations

• Liver function test normal.
• Kidney function test normal.
• Urinanalysis and culture negative.
• ESR 90 mm/1st hour.
• CRP 48mg/l. (Normal lt6 mg/dl ).
• Wrist X-ray delayed bone age ( 2.5 y).

11
Investigations

• Stool Rotazyme negative. Culture no growth,
  occult blood positive , colour green,
  appearance soft, WBC 42/HPF, RBC 55/HPF ,
  E. histolytica cyst and trophozoite.
• Stool analysis was repeated after 7 days of
  Metronidazole and it was negative for ova and
  cyst but many budding yeast were seen.

12
(No Transcript)
13
Course in hospital

• The patient was started on
• Metronidazole.
• Mesalazine .
• Prednisone .
• Azathioprine.

14
Course in hospital

• The patient developed severe diarrhea with poor
  oral intake and severe dehydration, hyponatremia
  and hypokalemia resulted and so I.V fluids were
  started for rehydration.
• -Oral thrush and budding yeast in stool so,
  Nystatin and Mycoheal was given.

15
Medication on Discharge

• Azathioprine 12.5 mg P.O Q 12 hr.
• Prednisone 5 mg tab Q 6 hrs.
• Mesalazine 250mg Q12hr.