Ulcerative Colitis


Step 1: View clinicals

A 23 year old woman presents with blood and mucus diarrhea, low grade fever, lethargy, and malaise for 1 week. She experienced around 3 to 4 bowel movements daily. She had several such episodes over the last 4 months, which were unsuccessfully treated with multiple courses of antibiotics. She had gone backpacking around South Asia 6 months earlier. An x-ray of her abdomen is found to be normal.

Step 2: Order all relevant investigations

Full Blood Count

WBC/DC: 8,700/mm3 N: 75% L: 23% Hb: 10.5 g/dl MCV: 88 fl MCH: 31.2 pg MCHC: 30 g/dl Platelets: 517,000/mm3

Tuberculin Test

The tuberculin test is negative.

Lower GI Endoscopy

The mucosa of the rectum and sigmoid colon appear uniformly inflamed, with multiple erosions. There is no contact bleeding. Biopsies show inflammation of the mucosa and submucosa only, with distortion of the crypts, crypt abscesses and lymphoid aggregates.

Stool Microscopy + Culture

Appearance: semi solid Pus cells: field full / hpf RBC: field full / hpf No amoeba, ova or cysts identified The stool cultures are negative

Step 3: Select appropriate management

Mesalazine stat
Azathioprine stat
Antituberculous therapy
Vancomycin stat

Score: ★★☆