Rapid Review: Ulcerative Colitis

Reviewed February 2024

Ulcerative Colitis

• Sx: bloody diarrhea, crampy abdominal pain, tenesmus
• PE: continuous mucosal inflammation, always involving the rectum, absence of perianal involvement (prevalent in Crohn)
• Extraintestinal findings: uveitis, erythema nodosum, peripheral arthritis, sacroiliitis, ankylosing spondylitis
• Tx: options depend on severity and location of disease
  • Mild-moderate: mesalamine, topical or oral steroids, 5-ASA
  • Severe: IV steroids +/- topical steroids initially, then anti-TNF or anti-integrin, colectomy for refractory cases (curative)
• Complications: toxic megacolon, ↑ colon cancer risk

Sample question:

A 23-year-old man presents to the clinic with persistent bloody and mucoid diarrhea, severe abdominal cramps, weight loss, and fatigue for the past 2 months. His vital signs are within normal limits. Examination is significant for tenderness in the left lower quadrant and hypogastrium. Stool culture, examination for ova and parasites, and Clostridioides difficile toxin assay are negative. A colonoscopy shows a friable mucosa with pseudopolyps involving the rectum, sigmoid, and left colon up to the transverse colon. Which of the following is the most suspected diagnosis?