Pseudomembranous colitis

Pseudomembranous colitis is an acute infective colitis which occurs when changes in the bowel flora allows overgrowth of clostridium difficile and thus production of its toxins (especially toxin A and B)

  • Watery diarrhoea – may be bloody
  • Fever
  • Abdominal pain
  • Raised WCC

Risk factors
  • Broad-spectrum antibiotic use, especially:
    • Clindamycin
    • Second and third generation cephalosporins
    • Fluoroquinolones
    • Carbapenem
  • Parenteral nutrition
  • Diabetes
  • Renal failure
  • Liver failure
  • Cystic fibrosis
  • Upper GI surgery
  • Malnutrition

  • Cytotoxin assay
  • Stool culture
  • Endoscopy
    • Cream/green pseudomembrane
  • AXR
    • Mucosal thickening
    • ‘thumbprinting’ (= wide transverse bands associated with haustral fold thickening)
  • CT abdomen
    • Wall thickening
    • ‘accordion sign’
    •  ‘target sign’

Complications of pseudomembranous colitis
  • Hypokalaemia
  • Renal failure
  • Hypoproteinaemia
  • Peritonitis
  • Toxic megacolon

  • Oral vancomycin (10 to 14 days) plus
    • ? IV metronidazole
    • ?? oral rifampicin
    • ?? IV immunoglobulin
  • Colectomy in extreme cases

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