№ 10Gastroenterology13 min read
Ulcerative colitis
1. Big picture
Ulcerative colitis (UC) is a chronic inflammatory bowel disease affecting the colon only, with inflammation that starts in the rectum and extends continuously proximally. The classic exam pattern is:
young adult + bloody diarrhea + urgency/tenesmus + continuous rectal colitis on colonoscopy.
The examiner wants you to distinguish UC from Crohn disease:
| Feature | Ulcerative colitis | Crohn disease |
|---|---|---|
| Site | Colon only | Any part of GI tract, mouth to anus |
| Rectum | Almost always involved | May be spared |
| Pattern | Continuous | Skip lesions |
| Depth | Mucosa/submucosa | Transmural |
| Bleeding | Common | Less common |
| Fistula/stricture | Uncommon | Common |
| Surgery | Colectomy can be curative for colitis | Surgery not curative |
The attached exam file specifically emphasizes that rectosigmoid involvement in UC is 85–100% and that the rectum is basically invariably involved.
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