A 26-year-old woman with ulcerative colitis has 8 bloody stools daily, fever 38.3°C and pulse 112/min. CRP is 84 mg/L and abdominal radiograph shows

Question

A 26-year-old woman with ulcerative colitis has 8 bloody stools daily, fever 38.3°C and pulse 112/min. CRP is 84 mg/L and abdominal radiograph shows no colonic dilatation. Flexible sigmoidoscopy shows severe active colitis with spontaneous bleeding. Stool cultures and C difficile testing have been sent. What is the most appropriate management?

Accepted Answer

Intravenous corticosteroid therapy plus thromboprophylaxis

Answer

Immediate elective ileal pouch surgery as the next step

Answer

Topical mesalazine monotherapy as the preferred next step

Answer

Loperamide and oral iron replacement as the next step

Answer

Oral prednisolone at home as the preferred next step

Acute severe ulcerative colitis — ESEGH MCQ