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)
Presentation
- 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
Diagnosis
- 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
Management
- Oral vancomycin (10 to 14 days) plus
- ? IV metronidazole
- ?? oral rifampicin
- ?? IV immunoglobulin
- Colectomy in extreme cases
References
