Key Points
- Stabilize ABCs; begin targeted evaluation without delaying life-saving therapy.
- Use system-specific risk tools to guide testing and disposition.
- Order high-yield tests first; escalate imaging when indicated.
- Start evidence-based initial therapy and reassess frequently.
Algorithm
- Primary survey and vitals; IV access and monitors.
- Focused history/physical; identify red flags and likely etiologies.
- Order system-appropriate labs and imaging (see Investigations).
- Initiate guideline-based empiric therapy (see Pharmacology).
- Reassess response; arrange consultation and definitive management.
Clinical Synopsis & Reasoning
For Microscopic Colitis Diagnosis Treatment, frame the differential by acuity and pathophysiology, then align diagnostics to the leading hypotheses. Prioritize stabilization while obtaining high‑yield studies such as CBC (Bleeding/anemia), CMP (LFTs/electrolytes), Lipase (if pancreatitis) (Pancreatic enzyme), CT Abd/Pelvis (selected) (Complications). Incorporate bedside imaging and targeted labs to define severity and identify complications; synthesize results with clinical trajectory to refine the working diagnosis and disposition needs.
Treatment Strategy & Disposition
Initiate disease‑directed therapy alongside supportive care, titrating to objective response. Pharmacologic options commonly include PPI (IV), Octreotide (variceal). Use validated frameworks (e.g., Common Associations/Triggers) to guide escalation and site of care. Address precipitating factors, de‑escalate empiric therapies with data, and arrange follow‑up for monitoring and risk‑factor modification; admit patients with instability, high risk of deterioration, or needs for close monitoring.
Management Notes
Use minimal systemic steroids; budesonide has high first‑pass metabolism. Ensure adequate calcium/vitamin D.
Epidemiology / Risk Factors
- NSAIDs/alcohol; biliary disease
Investigations
| Test | Role / Rationale | Typical Findings | Notes |
|---|---|---|---|
| CBC | Bleeding/anemia | Low Hgb | |
| CMP | LFTs/electrolytes | Abnormal LFTs | |
| Lipase (if pancreatitis) | Pancreatic enzyme | Elevated | |
| CT Abd/Pelvis (selected) | Complications | Findings vary |
Common Associations/Triggers
| Category | Examples |
|---|---|
| Medications | NSAIDs, PPIs, SSRIs |
| Autoimmune | Celiac disease |
| Bile acid malabsorption | Responds to cholestyramine |
| Smoking | Risk factor |
| Relapse | Common; maintenance often required |
Pharmacology
| Medication | Mechanism | Onset | Role in Therapy | Limitations |
|---|---|---|---|---|
| Acetaminophen | Analgesic/antipyretic | Hours | Symptom control as appropriate | Hepatotoxicity (overdose) |
| Ondansetron | 5-HT3 antagonism | Minutes | Antiemesis if needed | QT prolongation |
Prognosis / Complications
- Varies by etiology and bleeding severity; rebleeding/perforation
Patient Education / Counseling
- Explain red flags and when to seek emergent care.
- Reinforce medication adherence and follow-up plan.
References
- AGA Guideline — Microscopic Colitis — Link