Snap Shot A 23-year-old female presents with low grade fever, weight loss, cramps LLQ abdominal pain, bloody diarrhea, and a history of tenesmus. Flexible sigmoidoscopy reveals a granular, hyperemic, and friable rectal mucosa that bleeds easily on contact. Introduction An idiopathic auto-inflammatory disease of the colon unlikely infectious Always starts in the rectum and spreads proximal contiguous lesion and unlikely to have skip lesions Risk factors: family history of IBD most common in whites and Ashkenazi Jews slight increased prevalence in females presents in patients in their early 20's Can present in association with sacroiliitis large joint peripheral arthritis Presentation Symptoms fever colicky abdominal pain bloody diarrhea with mucus rectal bleeding joint tenderness symptoms of peritonitis Evaluation Abdominal radiograph colonic distension visible Barium enema shortening of the bowel loss of haustra small serration at the bowel edge from small ulcers lead pipe appearance Colonoscopy with biopsy diffuse and contiguous rectal involvement friable mucosal patches pseudopolyps crypt abscess with numerous PMNs Laboratory tests indicated when diagnosis is uncertain from colonoscopy ANCA (+) in ulcerative colitis and ASCA (+) in Crohn disease Differential Crohns disease variables that separate UC and Crohn's Disease Treatment Treatment depends on site and severity Mild distal colitis mesalamine enema (best initial step) corticosteroids Moderate colitis prednisone mesalamine sulfasalazine Severe colitis IV steroids cyclosporine surgical resection - total colectomy is curative Surgical total colectomy is curative and indicated if severe colitis biopsy shows dysplasia or carcinoma Prognosis, Prevention, and Complications Marked increased risk for colon cancer Toxic megacolon bowel exceeds a diameter of 6 cm perforation is common