History and exam

Key diagnostic factors

common

rectal bleeding

Bleeding severity and frequency is related to disease severity and extent.[25]​

Patients whose disease is mild and confined to the rectum (proctitis) or rectosigmoid area (distal colitis) often have an insidious presentation with intermittent rectal bleeding associated with the passage of mucus, and the development of mild diarrhea with <4 small loose stools per day.

diarrhea

Diarrhea is usually bloody; severity and frequency are related to disease severity and extent.[23]​

blood in stool

Patients have gross or occult blood on digital rectal exam.

Other diagnostic factors

common

abdominal pain

Pain severity and location depend on disease severity and extent. It can range from mild crampy pain associated with tenesmus to severe pain with either severe or complicated colitis (i.e., toxic megacolon, perforation).[39]

arthritis and spondylitis

Peripheral arthritis, ankylosing spondylitis, and undifferentiated spondyloarthropathy may be the presenting manifestation of UC.[40]

malnutrition

Nutritional deficiencies or the inability to maintain ideal body weight are frequent in adults with inflammatory bowel disease.[42]

Nutrient deficiency may be present even among patients whose disease is quiescent.

Serum concentrations of several nutrients (beta-carotene, vitamins A, C, D, and E, selenium, magnesium, and zinc) can be significantly reduced.[42]

A combination of factors contributes to the pathogenesis of malnutrition, including reduced nutrient intake, malabsorption, increased energy expenditure, and enteral protein loss.[42]

abdominal tenderness

Pain severity and location depend on disease severity and extent. Peritoneal signs are absent unless colitis is complicated.[39]

uncommon

fever

Fever is usually not present in mild, limited disease, but it can range from low-grade fever to high-grade fever with superimposed infection or toxic megacolon.[39]

weight loss

Weight loss is seen usually with moderate-to-severe disease. The loss may result from diarrhea, decreased intake, or both.[39]

constipation

Mild proctitis may be associated with periods of constipation.

skin rash

Patients may have erythema nodosum and pyoderma gangrenosum.[41]

uveitis and episcleritis

Uveitis is less common than episcleritis.

pallor

Patients have pale conjunctiva and membranes.

Risk factors

strong

family history of inflammatory bowel disease

Among patients with UC, 10% to 20% will have a family history of inflammatory bowel disease.[12][13]

In a population-based study, the risk of UC was increased in first-degree relatives (incident rate ratio [IRR] 4.08), second-degree relatives (IRR 1.85), and third-degree relatives (IRR 1.51) of patients with UC.[14]

Some have suggested that children with a below-average birth weight who are born to mothers with UC have a greater risk of developing the disease.

human leukocyte antigen-B27

Identified in most patients with UC. Several linkage studies suggest a susceptibility locus on chromosome 12; other loci on chromosomes 2, 3, 6, and 7 have been implicated.

infection

Up to 50% of relapses of colitis are associated with enteritis due to recognized pathogens.[20]

weak

use of nonsteroidal anti-inflammatory drugs (NSAIDs)

Use of NSAIDs, particularly nonselective ones, can cause a flare-up of disease in some patients.[7][21]​​​

not smoking or former smoker

Not smoking or being a former smoker is a risk for the development of UC.[22]

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