A fictional 29-year-old with ulcerative colitis presents with frequent bloody diarrhoea, abdominal pain, fever, tachycardia and anaemia.
Frame the danger first.
- Frequent bloody diarrhoea with systemic toxicity may indicate acute severe ulcerative colitis.
- Assess hydration, abdominal signs, thrombotic risk, infection and complications alongside disease activity.
- A benign abdominal examination can change quickly; repeated review matters.
Act, escalate, reassess.
- Admit, use ABCDE assessment and involve gastroenterology early through the local severe-colitis pathway.
- Obtain appropriate bloods, stool infection testing and imaging when clinically indicated without delaying escalation.
- Monitor stool frequency, vital signs, abdominal examination, fluid balance and inflammatory/biochemical trends.
- Discuss colorectal surgery early if deterioration, complication or failure to respond is possible.
Red flags that change pace.
- Peritonism, distension, severe tenderness, shock or rising lactate
- Fever, tachycardia, anaemia or worsening inflammatory/biochemical markers
- Concern about toxic megacolon, perforation or refractory disease
What makes care less safe.
- Managing severe bloody diarrhoea as routine outpatient flare
- Delaying surgical discussion until perforation or shock
- Using fixed rescue-therapy rules outside current gastroenterology guidance
Say the concern plainly.
Acute severe colitis: stool frequency/bleeding [trend], observations/abdomen [summary], infection testing [status], fluids/anaemia [details] and gastroenterology/colorectal plan [names].