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Ulcerative colitis flare — MCCQE Part 1 MCQ

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HardDiarrheaUlcerative colitis flareMCCQE Part 1

A 33-year-old man with ulcerative colitis has 8 bloody stools daily, fever and tachycardia. Haemoglobin is low and CRP is elevated. Which of the following is the most appropriate next step?

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Correct answer: A — Admit for assessment of acute severe colitis, stool studies and intravenous corticosteroids if infection is excluded or treated

Frequent bloody stools with systemic toxicity indicate acute severe ulcerative colitis requiring hospital assessment, stool testing including C. difficile and usually intravenous corticosteroids once infection is addressed. Loperamide can precipitate toxic megacolon in severe colitis. Haemorrhoids and dietary fibre do not explain systemic inflammatory features.

Reference: Canadian Association of Gastroenterology ulcerative colitis guideline