Synopsis
Diagnose ulcerative colitis, describe its continuous colonic extent and activity, and deliver steroid-sparing medical care with timely surveillance and surgical discussion.
- Ulcerative colitis is chronic mucosal inflammation beginning in the rectum and extending proximally in a usually continuous pattern; extent can change over time or appear modified by treatment.
- Bloody diarrhoea, urgency, tenesmus and nocturnal stool are typical, but diagnosis still requires stool infection assessment, endoscopy and histology rather than symptoms alone.
- Record proctitis, left-sided or extensive disease and quantify activity because topical reach, systemic risk, surveillance and treatment selection all depend on them.
Key red flags
Suspected acute severe colitis requires same-day hospital assessment with gastroenterology and colorectal surgery involvement from admission.
Investigation priorities
Exclude treatable infection at diagnosis and during clinically important flares.
Management branches
Persistent bloody diarrhoea, urgency or tenesmus raises suspicion of new ulcerative colitis.
- Assess haemodynamic and systemic severity first, admitting suspected acute severe disease rather than progressing through a routine outpatient pathway.
- Obtain blood and stool tests, including infection assessment, medication and travel history, and examine for abdominal, perianal and extra-intestinal findings.
Key medicines
MesalazineOral and rectal regimen matched to extent, formulation and licensed product instructions.
CorticosteroidTime-limited topical, oral or intravenous induction course selected by severity.