A 28-year-old with known UC presents with 10 bloody stools per day, abdominal pain, HR 112, temp 38.2. Talk through your assessment and management.

Question

Accepted Answer

This is acute severe UC by Truelove and Witts — bloody stools >6, tachycardia, fever. I'd resuscitate with IV fluids, send CRP, FBC, U&E, albumin, group and save, stool cultures including CDT, and request a plain AXR to exclude toxic megacolon. I'd start IV hydrocortisone 100 mg QDS, prescribe LMWH despite bleeding, ensure adequate nutrition with dietitian input, and book a flexi sig within 72 hours for histology and CMV. Crucially I'd inform the colorectal team on admission so they can co-manage and counsel about colectomy. At day 3 I'd review with the Travis criteria — if CRP is still >45 with >8 stools, colectomy risk is 85% so I'd start medical rescue with infliximab 5 mg/kg or ciclosporin, while keeping surgery on standby. Throughout I'd discuss prognosis honestly with the patient and family.

Acute severe ulcerative colitis

Framework checklists