Inflammatory bowel disease is lifelong immune inflammation of the gut, mainly Crohn disease and ulcerative colitis. Crohn disease can affect any part of the gut with patchy, full-thickness inflammation, while ulcerative colitis starts at the rectum and spreads continuously through the colon lining.
Key symptoms
- Diarrhea for weeks, often with blood or mucus in ulcerative colitis
- Crampy belly pain, often right lower in Crohn disease
- Urgency and a feeling of incomplete emptying
- Weight loss, fatigue and fever
- Mouth ulcers, joint pain, red eyes or skin lesions
What you find on exam
- Vital signs: fever, fast pulse or low pressure in a severe flare
- Abdominal tenderness or a right lower mass in Crohn disease
- Perianal fistulas, abscesses or skin tags
- Pallor and signs of weight loss
Tests
- Blood count, CRP, albumin, iron studies
- Fecal calprotectin to show gut inflammation
- Stool tests for infection, including C. difficile
- Colonoscopy with biopsies to confirm the diagnosis
- CT or MR enterography for small bowel Crohn disease and complications
Treatment basics
- Mild ulcerative colitis: mesalamine by mouth and rectally
- Flares: corticosteroids such as prednisone or IV methylprednisolone
- Maintenance with azathioprine or biologics such as infliximab, adalimumab or vedolizumab
- Surgery for strictures, fistulas, dysplasia or failed medical therapy
- Stop smoking (key in Crohn disease), vaccines and colon cancer surveillance
Red flags
- 6 or more bloody stools a day with fever or a fast pulse
- Severe pain, distension or a rigid belly (toxic megacolon or perforation)
- Signs of bowel obstruction or a perianal abscess
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.