Summary
Definition
History and exam
Key diagnostic factors
- rectal bleeding
- diarrhea
- blood in stool
Other diagnostic factors
- abdominal pain
- arthritis and spondylitis
- malnutrition
- abdominal tenderness
- fever
- weight loss
- constipation
- skin rash
- uveitis and episcleritis
- pallor
Risk factors
- family history of inflammatory bowel disease
- human leukocyte antigen-B27
- infection
- nonsteroidal anti-inflammatory drugs (NSAIDs)
- not smoking or former smoker
Diagnostic tests
1st tests to order
- stool studies for infective pathogens
- fecal calprotectin
- CBC
- comprehensive metabolic panel (including LFTs)
- erythrocyte sedimentation rate (ESR)
- CRP
- plain abdominal radiograph
- flexible sigmoidoscopy
- colonoscopy
- biopsies
Tests to consider
- CT scan
Treatment algorithm
acute severe ulcerative colitis
moderate-to-severe disease
mild disease
disease in remission
Contributors
Authors
Andrew Poullis, BSc, MBBS, MD, FRCP
Consultant Gastroenterologist
Department of Gastroenterology
St George’s Hospital
London
UK
Disclosures
AP is an author of a reference cited in this topic.
Aaron Bhakta, BMedSci (Hons), BMBS, MSc, MRCP
Clinical Fellow in Gastroenterology
Department of Gastroenterology
St George’s Hospital
London
UK
Disclosures
AB declares that he has no competing interests.
Acknowledgements
Dr Hesam A. Nooredinvand, and Dr Andrew Poullis would like to gratefully acknowledge Dr Ben Shandro, Dr Anet Soubieres, Dr Rhys Hewett, Dr Willem J.S. de Villiers, and Dr Houssam Mardini, previous contributors to this topic.
Disclosures
BS, AS, RH, WJSD, and HM declare that they have no competing interests.
Peer reviewers
Trevor Winter, MD, PhD
Associate Professor of Medicine
Division of Digestive Diseases and Nutrition
University of Kentucky
Lexington
KY
Disclosures
TW declares that he has no competing interests.
Sharon Stein, MD
Assistant Professor of Surgery
Division of Colon and Rectal Surgery
University Hospital Case Medical Center
Cleveland
OH
Disclosures
SS received a fee for educational courses on laparoscopic surgery, paid for in part by Covidien, Olympus, and Applied Medical.
Differentials
- Crohn disease
- Indeterminate colitis
- Radiation colitis
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