A 32-year-old male presents with recurrent episodes of bloody diarrhea, crampy lower abdominal pain, tenesmus, and weight loss. Colonoscopy reveals continuous mucosal erythema, loss of vascular pattern, and friability extending from the rectum up to the splenic flexure. What is the most likely diagnosis?

Answer and explanation

Correct answer: C. Ulcerative colitis

  1. Step 1: Examine disease characteristics: Continuous, superficial mucosal inflammation beginning at the rectum (proctitis) and extending proximally without skip lesions is diagnostic of ulcerative colitis.
  2. Step 2: Distinguish from Crohn's disease: Crohn's typically features transmural inflammation, skip lesions, granulomas, and cobblestoning, frequently sparing the rectum.
  3. Step 3: Conclude diagnosis: Ulcerative colitis.
Answer
Ulcerative colitis.
Why not the others: 'Crohn's disease' presents with patchy transmural involvement and perianal disease; 'Celiac disease' affects small intestinal mucosa resulting in malabsorption; 'Irritable bowel syndrome' is a functional bowel disorder with entirely normal endoscopic findings.

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