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Inflammatory bowel disease acute severe colitis — SCE Acute Medicine MCQ

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ModerateAcute GI PresentationsInflammatory bowel disease acute severe colitisSCE Acute Medicine

A 29-year-old woman is assessed on the acute medical unit. She has ulcerative colitis with six bloody stools daily, fever and tachycardia. CRP is 82 mg/L and abdominal radiograph shows no dilatation. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate next step in management?

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Correct answer: A — Give intravenous corticosteroids after excluding infection

Give intravenous corticosteroids after excluding infection is the best answer because acute severe UC is treated with intravenous steroids once infection including C. difficile is assessed. Start intravenous N-acetylcysteine promptly is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Early surgical awareness is needed if response is poor.

Reference: BSG IBD guideline