A fictional 29-year-old admitted with acute severe ulcerative colitis has received intravenous corticosteroids for three days. There are nine bloody stools in 24 hours, CRP remains 72 mg/L and abdominal distension is slightly worse; infection studies have not identified an alternative cause.
Listen for the assumption.
There is no perforation, so I thought we could continue the same treatment for another few days.
This is the planned response checkpoint. Persistent frequent stools, inflammation and changing abdominal findings require an IBD and colorectal decision now—not passive observation.
I will request immediate joint review for rescue medical therapy versus surgery and repeat the toxicity assessment.
Choose an answer below and reveal the reasoning to see consultant feedback at every checkpoint. The full consultant-led synthesis follows after all three decisions.
Go to the first decision ↓The picture develops.
- Nine bloody stools in 24 hours
- CRP 72 mg/L after three days of intravenous corticosteroids
- Increasing distension without radiographic perforation
Commit before you reveal.
After you select an option, reveal the model reasoning and the consultant’s feedback.
Hear the senior team refine the plan.
The registrar tests the plan, the consultant synthesises the key principle, and the SHO confirms the safer next steps.
Continue thromboprophylaxis unless contraindicated, nutrition and fluid/electrolyte care, infection surveillance and frequent abdominal assessment.
Explain both rescue and surgical pathways clearly. A second-line medicine is not permission for an open-ended trial; record response criteria and the next decision time.
I will document the response measures, rescue eligibility, operative concerns and a named time for reassessment.
What must remain explicit.
- Follow the current local ASUC pathway and 2025 BSG guidance.
- Keep colorectal surgery involved throughout rescue treatment.
- Escalate distension, tenderness, fever, tachycardia, hypotension or rising lactate immediately.
Where reasoning fails.
- Open-ended steroid treatment
- Serial rescue therapies without clear limits
- Treating surgical review as a last resort
ASUC day [number], stools [number/trend], CRP and observations [trend], abdomen/imaging [findings], infection results [status], steroid response [assessment] and rescue/surgical decision [time/owner].
Does your ASUC pathway state who makes the day-three decision and what happens overnight if the patient worsens?