A 30-year-old female presents with persistent bloody diarrhea (6-8 bowel movements daily), lower abdominal cramping, and tenesmus for 6 weeks. Colonoscopy demonstrates continuous, diffuse, superficial mucosal inflammation, erythema, and friability extending from the rectum up to the splenic flexure without skip lesions. What is the most likely diagnosis?
Answer and explanation
Correct answer: B. Ulcerative colitis
- Step 1: Analyze endoscopic features: Continuous mucosal involvement starting at the rectum and extending proximally without skip lesions and limited to the mucosa is classic for ulcerative colitis.
- Step 2: Crohn's disease typically causes patchy transmural inflammation, skip lesions, cobblestoning, and aphthous ulcers anywhere from mouth to anus.
Answer
Ulcerative colitis.
Why not the others: 'Crohn's disease' presents with transmural inflammation and non-caseating granulomas with rectal sparing; 'Celiac sprue' affects the small intestinal mucosa (duodenum/jejunum) causing malabsorption; 'Ischemic colitis' occurs typically in elderly patients at watershed areas (splenic flexure).
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