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Acute severe ulcerative colitis — SCE Acute Medicine MCQ

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HardAcute GI PresentationsAcute severe ulcerative colitisSCE Acute Medicine

A 25-year-old man with ulcerative colitis presents with eight bloody stools per day, fever and tachycardia. CRP is 128 mg/L, haemoglobin is 94 g/L and abdominal radiograph shows transverse colon diameter 5.4 cm. Stool cultures and C difficile toxin have been sent. What is the most appropriate next step in management?

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Correct answer: D — Admit for intravenous corticosteroids and close surgical-gastroenterology review

Frequent bloody stools with systemic toxicity indicate acute severe ulcerative colitis requiring admission, IV steroids and early multidisciplinary review. Antimotility drugs can precipitate toxic megacolon. Full colonoscopy can be hazardous in severe colitis and should not delay treatment. The pearl is that day-3 response to IV steroids guides rescue therapy or colectomy decisions.

Reference: BSG IBD guideline