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| __NOTOC__
| | #REDIRECT:[[Colitis]] |
| {{SI}}
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| {{CMG}}; {{AE}} {{QS}}
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| ==Overview==
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| '''Proctocolitis''' is a general term for [[inflammation]] of the [[rectum]] and [[Colon (anatomy)|colon]] particularly distal part of the colon([[sigmoid]])<ref>Online Medical dictionary[http://cancerweb.ncl.ac.uk/cgi-bin/omd?proctocolitis]</ref>. Common causes of proctocolitis include ''[[Chlamydia trachomatis]]'', ''[[Lymphogranuloma Venereum]]'', ''[[Neisseria gonorrhoeae]]'', [[Herpes Simplex Virus|HSV]], and [[Campylobacter]] species. The mainstay of therapy for infectious proctocolitis is [[antimicrobial]] therapy. The preferred regimen is a combination of [[Ceftriaxone]] and [[Doxycycline]]. Proctocolitis may be acute or chronic.
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| ==Historical Perspective==
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| ==Classification==
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| There is no established classification system for proctocolitis. However, it may be classified based on etiology, age and duration of symptom.
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| ===Classification by etiology===
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| *[[Infectious]]
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| **Viral
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| **Bacterial
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| **Fungal,
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| **Protozoan
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| **Atypical micro-organism.
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| *[[Allergic (eosinophilic)]]
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| *[[Vascular]]
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| *[[Autoimmune]]
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| *[[Drug-induced]]
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| *[[Radiation]]
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| *[[Chemical]]
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| *[[Idiopathic]]
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| ===Classification by Age===
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| * '''Infantile''': More common in early infancy (first six months).<ref name="pmid25976434">{{cite journal| author=Nowak-Węgrzyn A| title=Food protein-induced enterocolitis syndrome and allergic proctocolitis. | journal=Allergy Asthma Proc | year= 2015 | volume= 36 | issue= 3 | pages= 172-84 | pmid=25976434 | doi=10.2500/aap.2015.36.3811 | pmc=4405595 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25976434 }} </ref><ref name="pmid11264489">{{cite journal| author=Pumberger W, Pomberger G, Geissler W| title=Proctocolitis in breast fed infants: a contribution to differential diagnosis of haematochezia in early childhood. | journal=Postgrad Med J | year= 2001 | volume= 77 | issue= 906 | pages= 252-4 | pmid=11264489 | doi= | pmc=1741985 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11264489 }} </ref><ref name="pmid21922029">{{cite journal| author=Alfadda AA, Storr MA, Shaffer EA| title=Eosinophilic colitis: epidemiology, clinical features, and current management. | journal=Therap Adv Gastroenterol | year= 2011 | volume= 4 | issue= 5 | pages= 301-9 | pmid=21922029 | doi=10.1177/1756283X10392443 | pmc=3165205 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21922029 }} </ref>
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| * '''Adults'''
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| ===Classification by duration of symptoms===
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| *Acute: for example allergic proctocolitis in infants.
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| *Chronic: Usually months to years, for example ulcerative colitis.
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| ==Pathophysiology==
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| The pathophysiology of proctocolitis depends on the cause. Some of the pathogenetic mechanisms are not fully understood.
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| ===Pathogenesis===
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| '''Hypothesis regarding pathogenesis of Allergic proctocolitis'''
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| *It is a non IgE immunological reaction against food protein antigens which is thought to be T cell mediated resulting in Eosinophil accumulation in the intestinal tract and subsequent inflammation.<ref name="pmid11264489">{{cite journal| author=Pumberger W, Pomberger G, Geissler W| title=Proctocolitis in breast fed infants: a contribution to differential diagnosis of haematochezia in early childhood. | journal=Postgrad Med J | year= 2001 | volume= 77 | issue= 906 | pages= 252-4 | pmid=11264489 | doi= | pmc=1741985 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11264489 }} </ref><ref name="pmid21762530">{{cite journal| author=Lucarelli S, Di Nardo G, Lastrucci G, D'Alfonso Y, Marcheggiano A, Federici T et al.| title=Allergic proctocolitis refractory to maternal hypoallergenic diet in exclusively breast-fed infants: a clinical observation. | journal=BMC Gastroenterol | year= 2011 | volume= 11 | issue= | pages= 82 | pmid=21762530 | doi=10.1186/1471-230X-11-82 | pmc=3224143 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21762530 }} </ref><ref name="pmid25125777">{{cite journal| author=Chesworth BM, Hamilton CB, Walton DM, Benoit M, Blake TA, Bredy H et al.| title=Reliability and validity of two versions of the upper extremity functional index. | journal=Physiother Can | year= 2014 | volume= 66 | issue= 3 | pages= 243-53 | pmid=25125777 | doi=10.3138/ptc.2013-45 | pmc=4130402 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25125777 }} </ref>
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| *Could also be an autoimmune disease. Atypical p antineutrophil cytoplasmic antibodies (a-pANCA) have been seen in some infants with intestinal infiltration by Neutrophils.<ref name="pmid26484355">{{cite journal| author=Sekerkova A, Fuchs M, Cecrdlova E, Svachova V, Kralova Lesna I, Striz I et al.| title=High Prevalence of Neutrophil Cytoplasmic Autoantibodies in Infants with Food Protein-Induced Proctitis/Proctocolitis: Autoimmunity Involvement? | journal=J Immunol Res | year= 2015 | volume= 2015 | issue= | pages= 902863 | pmid=26484355 | doi=10.1155/2015/902863 | pmc=4592904 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26484355 }} </ref>
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| '''Pathogenesis of Infectious proctocolitis'''
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| *Acquired commonly as a sexually transmitted infection (STI) among individuals who practice unsafe anal sex.
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| *The pathogens are usually transmitted directly through the rectal mucosa or indirectly via oral-anal contact.
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| *Inoculation and replication of ''C. trachomatis'' [[Serovar|serovars]] L1, L2, or L3 depends on alternation between two forms of the bacterium: the infectious elementary body (EB) and noninfectious, replicating reticulate body (RB).<ref name="pmid11159992">{{cite journal| author=Taraktchoglou M, Pacey AA, Turnbull JE, Eley A| title=Infectivity of Chlamydia trachomatis serovar LGV but not E is dependent on host cell heparan sulfate. | journal=Infect Immun | year= 2001 | volume= 69 | issue= 2 | pages= 968-76 | pmid=11159992 | doi=10.1128/IAI.69.2.968-976.2001 | pmc=PMC97976 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11159992 }} </ref>
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| *The EB form is responsible for inoculation with ''C. trachomatis''.
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| :*The ''C. trachomatis'' EB enters the body through skin abrasions, microabrasions incurred during sexual intercourse or by crossing [[epithelial cells]] of [[mucous membranes]].<ref name="pmid12081191">{{cite journal| author=Mabey D, Peeling RW| title=Lymphogranuloma venereum. | journal=Sex Transm Infect | year= 2002 | volume= 78 | issue= 2 | pages= 90-2 | pmid=12081191 | doi= | pmc=PMC1744436 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12081191 }} </ref>
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| *Once inside the host cell, EBs immediately start differentiating into reticulate bodies (RBs) that undergo replication.
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| *The process of endocytosis and accumulation of RBs within host epithelial cells causes host cell destruction ([[necrosis]]) which leads to the formation of a [[papule]] at the site of inoculation which may ulcerate, depending on the extent of infection and number or EBs transmitted.<ref name="pmid2030670" />
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| *''[[Shigella]]'' first invades the epithelial cells of the large intestine by using M cells as entry ports for transcytosis. Shigella then invades macrophages and induces cellular apoptosis, which results in inflammation, generation of proinflammatory cytokines, and recruitment of polymorphonuclear neutrophils (PMNs).
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| ==Causes==
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| Proctocolitis has many possible causes. Common infectious causes of proctocolitis include ''[[Chlamydia trachomatis]]'', [[Lymphogranuloma Venereum|LGV (Lymphogranuloma Venereum)]], ''[[Neisseria gonorrhoeae]]'', [[Herpes Simplex Virus|HSV]], and [[Campylobacter|Campylobacter species]]. It can also be idiopathic (see [[colitis]]), vascular (as in [[ischemic colitis]]), or autoimmune (as in [[inflammatory bowel disease]]).
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| ===Life Threatening Causes===
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| ===Common Causes===
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| ===Causes by Organ System===
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| {|style="width:80%; height:100px" border="1"
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| |style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
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| |style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
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| |-
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| |bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Dental'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Dermatologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Drug Side Effect'''
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| |bgcolor="Beige"| [[Chlorpropamide]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Ear Nose Throat'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Endocrine'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Environmental'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Gastroenterologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Genetic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Hematologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Iatrogenic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Infectious Disease'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Musculoskeletal/Orthopedic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Neurologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Nutritional/Metabolic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Obstetric/Gynecologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Oncologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Ophthalmologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Overdose/Toxicity'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Psychiatric'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Pulmonary'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Renal/Electrolyte'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Rheumatology/Immunology/Allergy'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Sexual'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Trauma'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Urologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Miscellaneous'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |}
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| ===Causes in Alphabetical Order===
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| {{col-begin|width=80%}}
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| {{col-break|width=33%}}
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| * [[Chlorpropamide]]
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| {{col-break|width=33%}}
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| * Disease B
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| {{col-break|width=33%}}
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| * Disease C
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| {{col-end}}
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| ==Differentiating {{PAGENAME}} from Other Diseases==
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| ==Epidemiology and Demographics==
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| ==Risk Factors==
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| ==Screening==
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| ==Natural History, Complications, and Prognosis==
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| ===Natural History===
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| ===Complications===
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| ===Prognosis===
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| ==Diagnosis==
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| ===Diagnostic Criteria===
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| ===History and Symptoms===
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| ===Physical Examination===
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| ===Laboratory Findings===
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| ===Imaging Findings===
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| ===Other Diagnostic Studies===
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| ==Treatment==
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| ===Medical Therapy===
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| *All patients with proctocolitis should be treated.
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| *Treatment of proctocolitis is similar to that of proctitis.
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| *Generally, the following regimen is recommended:
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| :: Preferred regimen: [[Ceftriaxone]] 250 mg IM {{and}} [[Doxycycline]] 100 mg PO bid for 7 days
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| To view additional treatment and special considerations for the management of proctitis/proctocolitis, click [[proctitis medical therapy|'''here''']].
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| ===Surgery===
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| ===Prevention===
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| ==See also==
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| * [[Colitis]]
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| * [[Proctitis]]
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| ==References==
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| {{reflist|2}}
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| [[Category:Gastroenterology]]
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