NBME Step 2 CK Form 8 Toxic megacolon (NBME Answers)

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submitted by ∗step_prep3(25)

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Young patient with concern for IBD (increased stool frequency, signs of inflammation [fatigue, weight loss], bloody stools) who presents with ill-appearance, fever, hypotension, abdominal distention and an X-ray showing dilated transverse colon, consistent with toxic megacolon in setting of ulcerative colitis
Key idea: Toxic megacolon associated with ulcerative colitis and C. diff colitis
Colonic pseudo-obstruction often seen in elderly patient who is post-op and/or received opiates, diverticulitis leads to LLQ pain in an elderly patient, and ischemic colitis leads to “pain out of proportion” in a patient with risk factors (atrial fibrillation, endocarditis, etc.)

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killuashi Would toxic megacolon only show up in one part of the bowel? Shouldn't the whole bowel be dilated in toxic megacolon and not just the transverse colon? +1

ht3 ^I thought that too but also isn't toxic megacolon painful...? or nah? +

danielle359x Toxic megacolon is typically most prominent in the transverse colon. According to UpToDate, 82% of cases present with pain. I feel like they didn't need to emphasize twice that the patient had no pain, but that's NBME for you... +1