Clinical features

Ask about

• speed of onset ^c  
• any diarrhoea ^a
  • its duration ^c
  • the number of bowel movements per day at onset ^c  
• any fever ^c  
• any recent travel abroad ^c  
• any weight loss ^a 
• a family history of inflammatory bowel disease ^a 

• macroscopically bloody stool
• severe abdominal pain
• vomiting   
• dehydration or hypovolaemia ^d
• evidence of septicaemia or septic shock ^d
• evidence of perforation ^d
  

Known Crohn's disease

• their general well-being in the last 24 hours
• any abdominal pain in the last 24 hours
• the number of liquid stools per day

• an abdominal mass
• any systemic complications 
  • arthralgia
  • uveitis
  • erythema nodosum, pyoderma gangrenosum
  • aphthous ulcers
  • anal fissure
  • new fistula
  • abscess

• weight loss > 2.5 kg
• lower gastrointestinal bleeding
• anal fissures or abscesses   
• dehydration or hypovolaemia ^d
• evidence of septicaemia or septic shock ^d
• evidence of perforation ^d
  

Known ulcerative colitis

• number of bowel motions per day, and whether there was any blood ^c

• tachycardia
• evidence of septicaemia or septic shock ^d
  • fever
  • raised ESR
• anaemia
• dehydration or hypovolaemia ^d
• evidence of perforation ^d

• Deep ulceration is common, but clinical features cannot predict which patients have it. ^c Further investigations are required. ^b