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Difference between revisions of "Pseudomembranous colitis"
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{{ Infobox diagnosis | |||
| Name = {{PAGENAME}} | |||
| Image = Colonic_pseudomembranes_intermed_mag.jpg | |||
| Width = | |||
| Caption = Colonic pseudomembrane. [[H&E stain]]. | |||
| 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 | |||
| Subtypes = | |||
| LMDDx = [[cap polyposis]], [[signet ring cell carcinoma]] (uncommonly), [[ischemic colitis]] in general | |||
| Stains = | |||
| IHC = | |||
| EM = | |||
| Molecular = | |||
| IF = | |||
| Gross = | |||
| Grossing = | |||
| Site = [[colon]] | |||
| Assdx = | |||
| Syndromes = | |||
| Clinicalhx = +/-prior treatment with antibiotics for something else | |||
| Signs = | |||
| Symptoms = diarrhea, abdominal pain, fever | |||
| Prevalence = uncommon | |||
| Bloodwork = | |||
| Rads = | |||
| Endoscopy = pseudomembranes (pale yellow (or white) irregular, raised mucosal lesions), interlesional mucosa often near normal grossly | |||
| Prognosis = dependent on comorbidities | |||
| Other = ''C. difficile'' toxin test positive (may be negative) | |||
| ClinDDx = | |||
| 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. difficile'' infections; however, may be seen in a number of different situations. | |||
==General== | |||
*''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> | |||
*[[C. difficile]]. | |||
**Known as ''C. difficile colitis''. | |||
*[[Ischemic colitis]]. | |||
**Volvulus. | |||
*Other infections. | |||
Etiology: | |||
*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== | |||
Features:<ref>URL: [http://radiology.uchc.edu/eAtlas/GI/1749.htm http://radiology.uchc.edu/eAtlas/GI/1749.htm]. Accessed on: 22 May 2012.</ref> | |||
*Pseudomembranes: | |||
**Pale yellow (or white) irregular, raised mucosal lesions. | |||
**Early lesions: typical <10 mm. | |||
*Interlesional mucosa often near normal grossly. | |||
===Images=== | |||
<gallery> | |||
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> | |||
==Microscopic== | |||
Features:<ref name=Ref_PBoD837-8>{{Ref PBoD|837-8}}</ref> | |||
*Heaped necrotic surface epithelium. | |||
**Described as "volanco lesions" - this is what is seen endoscopically. | |||
*[[PMN]]s in lamina propria. | |||
*+/-Capillary fibrin thrombi. | |||
Notes: | |||
*Pseudomembranes arise from the crypts. | |||
*Rarely have (benign) [[signet ring cell]]-like cells.<ref name=pmid12684766>{{Cite journal | last1 = Abdulkader | first1 = I. | last2 = Cameselle-Teijeiro | first2 = J. | last3 = Forteza | first3 = J. | title = Signet-ring cells associated with pseudomembranous colitis. | journal = Virchows Arch | volume = 442 | issue = 4 | pages = 412-4 | month = Apr | year = 2003 | doi = 10.1007/s00428-003-0779-1 | PMID = 12684766 }}</ref> | |||
DDx: | |||
*[[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=== | |||
<gallery> | |||
Image:Colonic_pseudomembranes_low_mag.jpg | Pseudomembranes - low mag. (WC/Nephron) | |||
Image:Colonic_pseudomembranes_intermed_mag.jpg | Pseudomembranes - intermed. mag. (WC/Nephron) | |||
</gallery> | |||
www: | |||
*[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== | |||
*[[Ischemic colitis]]. | |||
*[[Colon]]. | |||
*[[Toxic megacolon]]. | |||
==References== | |||
{{Reflist|2}} | |||
[[Category:Diagnosis]] | [[Category:Diagnosis]] | ||
[[Category:Colon]] | |||