We discussed a case of a middle aged woman who presented with acute on chronic abdominal pain, bloody diarrhea, tenesmus, found to have a new diagnosis of ulcerative colitis.

Clinical manifestations

• Abdominal pain, weight loss, diarrhea, urgency, incontinence, tenesmus
• Ask about characteristics of stool (frequency and presence of blood)
• Ask about GI infectious exposures

Important initial workup

• R/o infection (C diff, enteric pathogen panel, CMV)
• Stool calprotectin
• Inflammatory markers (e.g. CRP)
• Can consider imaging to r/o toxic megacolon / serious complications if pretest probability is high

Important daily interventions

• Pts with active IBD or exacerbations are at high risk of DVTs. Start DVT prophylaxis (LMWH, unfractionated heparin, fondaparinux)
• Mechanical DVT prophylaxis if there is severe GI bleeding (e.g. hypotension / shock)

Treatment (main categories)

• 5-ASA (e.g. mesalamine)
• Glucocorticoids
• Immunomodulators (e.g. azathioprine)
• Biologics (e.g. infliximab)
• Surgery