Chronic relapsing inflammation of colonic mucosa, starting in rectum, continuous.
History taking
- • Bloody diarrhoea, urgency, tenesmus
- • Extraintestinal: arthritis, uveitis, PSC, skin
Examination
- • General: vitals, pallor, icterus, oedema, lymphadenopathy
- • Focused system examination
- • Look for red-flag findings
Red flags
- • Haemodynamic instability
- • Rapid deterioration
- • Severe pain or new neurological deficit
Differential diagnosis
- • See differentials section per chief complaint
Recommended investigations
- • Colonoscopy + biopsy
- • Faecal calprotectin, CRP, CBC, LFT
- • Stool MCS + C. difficile
Diagnosis
- • Clinical diagnosis supported by targeted investigations
Initial treatment / management
- • Treat underlying cause
- • Symptomatic relief
- • Patient education
Drug therapy
- • Induction: oral/topical 5-ASA (mesalazine)
- • Steroids for flares
- • Azathioprine / biologics for moderate-severe
- • Maintenance with mesalazine ± immunomodulator
Follow-up advice
- • Surveillance colonoscopy from 8 years (cancer risk)
Patient counselling
- • Explain diagnosis and natural course in lay terms
- • Red-flag symptoms warranting urgent return
- • Adherence to medications and follow-up
Referral criteria
- • Refer if diagnostic uncertainty, complications, or failure of first-line therapy
References
- • Harrison's Principles of Internal Medicine, 21e
- • NICE / WHO guidelines (current edition)
Educational outpatient guide — verify against local guidelines before clinical use.
