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Severe ulcerative colitis — RCPSC IM MCQ

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HardGastroenterology/HepatologySevere ulcerative colitisRCPSC IM

A 28-year-old woman with ulcerative colitis has 9 bloody stools daily, fever and tachycardia. CRP is 98 mg/L, hemoglobin is 93 g/L, albumin is 26 g/L, abdominal radiograph shows colonic diameter 4.8 cm, and stool testing for C difficile is pending. Flexible sigmoidoscopy shows deep ulceration. What is the most appropriate management?

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Correct answer: A — Admit for intravenous corticosteroids, venous thromboembolism prophylaxis and early rescue-therapy planning

Acute severe ulcerative colitis requires hospital admission, infection testing, intravenous corticosteroids, thromboprophylaxis and early surgical or biologic rescue planning. Antimotility agents are avoided when severe colitis is present.

Reference: Canadian Association of Gastroenterology ulcerative colitis guidance