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Difference between revisions of "Pseudomembranous colitis"
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| Width = | | Width = | ||
| Caption = Colonic pseudomembrane. [[H&E stain]]. | | Caption = Colonic pseudomembrane. [[H&E stain]]. | ||
| Synonyms = | | Synonyms = ''C. difficile colitis'' '''not''' the same from the perspective of pathology; however, ''pseudomembranous colitis'' is commonly used as synonym for ''C. difficile colitis'' by clinicians | ||
| Micro = heaped necrotic surface epithelium (described as "volanco lesions"), [[PMN]]s in lamina propria, +/-capillary fibrin thrombi | | Micro = heaped necrotic surface epithelium (described as "volanco lesions"), [[PMN]]s in lamina propria, +/-capillary fibrin thrombi | ||
| Subtypes = | | Subtypes = | ||
| LMDDx = [[cap polyposis]] | | LMDDx = [[cap polyposis]], [[signet ring cell carcinoma]] (uncommonly), [[ischemic colitis]] in general | ||
| Stains = | | Stains = | ||
| IHC = | | IHC = | ||
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| Assdx = | | Assdx = | ||
| Syndromes = | | Syndromes = | ||
| Clinicalhx = | | Clinicalhx = +/-prior treatment with antibiotics for something else | ||
| Signs = | | Signs = | ||
| Symptoms = | | Symptoms = diarrhea, abdominal pain, fever | ||
| Prevalence = uncommon | | Prevalence = uncommon | ||
| Bloodwork = | | Bloodwork = | ||
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| Endoscopy = pseudomembranes (pale yellow (or white) irregular, raised mucosal lesions), interlesional mucosa often near normal grossly | | Endoscopy = pseudomembranes (pale yellow (or white) irregular, raised mucosal lesions), interlesional mucosa often near normal grossly | ||
| Prognosis = dependent on comorbidities | | Prognosis = dependent on comorbidities | ||
| Other = | | Other = ''C. difficile'' toxin test positive (may be negative) | ||
| ClinDDx = | | ClinDDx = | ||
| Tx = dependent on underlying cause, antibiotics in ''C. | | Tx = dependent on underlying cause, antibiotics in ''C. difficile'' - occasionally surgical resection | ||
}} | }} | ||
'''Pseudomembranous colitis''' an inflammation of the [[colon]] ([[colitis]]) with a characteristic endoscopic/gross appearance. It is closely associated with ''C. | '''Pseudomembranous colitis''' an inflammation of the [[colon]] ([[colitis]]) with a characteristic endoscopic/gross appearance. It is closely associated with ''C. difficile'' infections; however, may be seen in a number of different situations. | ||
==General== | ==General== | ||
*''Pseudomembranous colitis'' is a histomorphologic description which has a [[DDx]]. In other words, it can be caused by a number of things. | *''Pseudomembranous colitis'' is a histomorphologic description which has a [[DDx]]. In other words, it can be caused by a number of things. | ||
===Etiology=== | |||
DDx of pseudomembranous colitis:<ref name=Ref_PBoD837-8>{{Ref PBoD|837-8}}</ref> | DDx of pseudomembranous colitis:<ref name=Ref_PBoD837-8>{{Ref PBoD|837-8}}</ref> | ||
*[[C. difficile]]. | *[[C. difficile]]. | ||
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Etiology: | Etiology: | ||
*Anything that causes a severe mucosal injury. | *Anything that causes a severe mucosal injury. | ||
===Clostridium difficile=== | |||
{{Main|Clostridium difficile}} | |||
Epidemiology of ''[[C. difficile]]'' pseudomembranous colitis:<ref name=pmid23103666>{{Cite journal | last1 = Jones | first1 = AM. | last2 = Kuijper | first2 = EJ. | last3 = Wilcox | first3 = MH. | title = Clostridium difficile: a European perspective. | journal = J Infect | volume = 66 | issue = 2 | pages = 115-28 | month = Feb | year = 2013 | doi = 10.1016/j.jinf.2012.10.019 | PMID = 23103666 }}</ref> | |||
*Antibiotics prior to onset (classic history).<ref name=pmid23253319>{{Cite journal | last1 = Bassetti | first1 = M. | last2 = Villa | first2 = G. | last3 = Pecori | first3 = D. | last4 = Arzese | first4 = A. | last5 = Wilcox | first5 = M. | title = Epidemiology, diagnosis and treatment of Clostridium difficile infection. | journal = Expert Rev Anti Infect Ther | volume = 10 | issue = 12 | pages = 1405-23 | month = Dec | year = 2012 | doi = 10.1586/eri.12.135 | PMID = 23253319 }}</ref> | |||
*Typically hospitalized. | |||
*Typically older individuals. | |||
Clinical:<ref name=pmid8828001>{{Cite journal | last1 = Gröschel | first1 = DH. | title = Clostridium difficile infection. | journal = Crit Rev Clin Lab Sci | volume = 33 | issue = 3 | pages = 203-45 | month = | year = 1996 | doi = 10.3109/10408369609083061 | PMID = 8828001 }}</ref> | |||
*Diarrhea - usu. non-bloody - classic finding. | |||
*+/-Fever. | |||
*+/-Abdominal pain. | |||
==Gross== | ==Gross== | ||
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===Images=== | ===Images=== | ||
<gallery> | <gallery> | ||
Image:Pseudomembranous_colitis.JPG | Pseudomembranous colitis. (WC) | Image:Pseudomembranous_colitis_1.jpg | Pseudomembranous colitis - endoscopic image. (WC/Samir) | ||
Image:Pseudomembranous_colitis.JPG | Pseudomembranous colitis. (WC/Doc James) | |||
Image:Pseudomembranous_Colitis,_Colectomy_(Gross)_(7410584264).jpg | Pseudomembranous colitis. (WC/Euthman) | |||
</gallery> | </gallery> | ||
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DDx: | DDx: | ||
*[[Cap polyposis]] - very rare. | *[[Cap polyposis]] - very rare. | ||
*[[Signet ring cell carcinoma]]. | |||
*[[Ischemic colitis]] - in general. | |||
*Pseudomembranes associated with [[collagenous colitis]] - small case series reported.<ref name=pmid14508399>{{Cite journal | last1 = Yuan | first1 = S. | last2 = Reyes | first2 = V. | last3 = Bronner | first3 = MP. | title = Pseudomembranous collagenous colitis. | journal = Am J Surg Pathol | volume = 27 | issue = 10 | pages = 1375-9 | month = Oct | year = 2003 | doi = | PMID = 14508399 }}</ref> | |||
===Images=== | ===Images=== | ||
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www: | www: | ||
*[http://path.upmc.edu/cases/case153.html Pseudomembranous colitis (upmc.edu)]. | *[http://path.upmc.edu/cases/case153.html Pseudomembranous colitis (upmc.edu)]. | ||
==Sign out== | |||
*It is worth mentioning that ''pseudomembranous colitis'' has a [[differential diagnosis]] when considered from the morphology. | |||
==See also== | ==See also== | ||
*[[Ischemic colitis]]. | *[[Ischemic colitis]]. | ||
*[[Colon]]. | *[[Colon]]. | ||
*[[Toxic megacolon]]. | |||
==References== | ==References== | ||