Inflammatory bowel disease

Presents with weight loss, abdominal pain and diarrhoea which usually contains blood. Complications of ulcerative colitis include perforation and toxic megacolon while complications of Crohn's disease include fistulae, abscesses and perforations.

Management involves:

1. Fluid and electrolyte replacement.

2. Blood transfusion to maintain haemoglobin >7g/dl.

3. High dose steroids IV and, if distal bowel involvement, by enema.

4. Nutrition (often parenteral).

5. Regular surgical review. Surgery may be indicated if symptoms fail to settle after 5-7 days, for toxic megacolon, perforation, abscesses or obstruction.

6. Antidiarrhoeal drugs should be avoided.

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