Ulcerative colitis


  • Inflammation tends to be progressively more severe from proximal to distal colon
  • Rectum is almost always involved
  • Peak incidence occurs in second and third decades of life

Clinical Features


  • Mild
    • <4 bowel movements per day
    • No systemic symptoms
    • Few extraintestinal manifestations
    • Occasional constipation and rectal bleeding
  • Moderate
  • Severe
    • Frequent BM
    • Anemia
    • Fever
    • Weight loss
    • Frequent extraintestinal manifestations
    • Pancolitis

Differential Diagnosis




  • CBC
  • Chemistry
  • Fecal calprotectin[1] (typically requested by GI)
  • Type and screen
  • Imaging
    • Consider CT based on clinical features


  1. Rule-out complications:
    • Hemorrhage
    • Toxic megacolon
      • Develops in advanced disease when all the layers of the colon become involved
      • Presentation
        • Severely ill
        • Abdomen distended, tender, peritonitis
        • Fever, tachycardia
        • Leukocytosis (may be masked if patient taking steroids)
      • Perforation results in high mortality
      • Abdominal x-ray: long, continuous segment of air-filled colon >6cm in diameter
    • Perirectal fistula
    • Perirectal abscess
    • Obstruction (due to stricture)
    • Carcinoma
  2. Steroids
    • Parenteral vs PO depending on severity
      • PO: prednisone 40mg x 2wks, then decrease by 5mg per week


  • Admit for severe complication or severe flare requiring IV steroids

See Also


  1. van Rheenen PF, Van de Vijver E, Fidler V. Faecal calprotectin for screening of patients with suspected inflammatory bowel disease: diagnostic meta-analysis. BMJ. 2010;15(341):c3369.
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