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Course involves repeated flares and remissions. More common among non-
smokers, Ashkenazi Jews, and those with a family history. See Table 11.3 for a
comparison with Crohn disease.

SYMPTOMS/EXAM

■ Bloody diarrhea, crampy abdominal pain, fecal urgency, tenesmus
■ Abdominal tenderness to palpation grossly bloody stool on digital rectal exam
■ Extraintestinal manifestations common (see Table 11.8)

DIFFERENTIAL

Infectious etiology, Crohn disease, ischemic, toxic, pseudomembranous, radia-
tion colitis

DIAGNOSIS

■ Sigmoidoscopy or colonoscopy demonstrates continuous circumferential
ulceration.
■ Biopsy shows acute and chronic inflammation, crypt abscesses, no granulomas.

TREATMENT

■ Treatment depends on location and severity of disease. Mild disease can
be managed outpatient with follow-up.
■ Fluid resuscitation, electrolyte replacement, broad spectrum antibiotics
and admission are indicated for patients with fulminant colitis.
■ Distal disease: Mesalamine or hydrocortisone enema or suppository
■ Diffuse disease: Oral or IV medications
■ Mild to moderate:
■ Sulfasalazine
■ Mesalamine
■ Prednisone
■ Severe disease: Methylprednisolone, occasionally infliximab
■ Colectomy may be indicated if no response in 7–10 days.

COMPLICATIONS

Lower GI bleeding, toxic megacolon, colorectal cancer, extraintestinal mani-
festations (see Table 11.8)

ABDOMINAL AND GASTROINTESTINAL

EMERGENCIES

Avoid sigmoidoscopy and

colonoscopy in patients with

ulcerative colitis if there is a

severe flare because they

increase the risk of

perforation.

Surgery can be curative and

can eliminate the risk of

colorectal cancer in patients

with ulcerative colitis.

TABLE 11.8. Extraintestinal Manifestations of Ulcerative Colitis

Arthritic Peripheral arthritis, ankylosing spondylitis

Opthalmologic Uveitis, episcleritis

Dermatologic Pyoderma gangrenosum, erythema nodosum, oral apthous ulcers

Hepatobiliary Pericholangitis, chronic active hepatitis, cirrhosis, cholelithiasis, bile

duct carcinoma

There is a 10- to 30-fold

increase in the risk of

developing colorectal cancer

with ulcerative colitis. Risk

increases with duration and

extensiveness of disease.