A fictional 31-year-old with ulcerative colitis is admitted with frequent bloody stools, tachycardia, anaemia and raised inflammatory markers.
Listen for the assumption.
I planned intravenous steroids and would contact surgery only if rescue therapy failed.
Surgical involvement starts early. Infection testing, thromboprophylaxis, imaging and daily objective assessment must run alongside steroid treatment.
I will make the reassessment point and escalation options explicit from admission.
Choose an answer below and reveal the reasoning to see consultant feedback at every checkpoint. The full consultant-led synthesis follows after all three decisions.
Go to the first decision ↓The picture develops.
- Frequent bloody stools with systemic toxicity
- Abdominal distension is increasing
- Stool infection testing is pending
Commit before you reveal.
After you select an option, reveal the model reasoning and the consultant’s feedback.
Hear the senior team refine the plan.
The registrar tests the plan, the consultant synthesises the key principle, and the SHO confirms the safer next steps.
Track stool frequency, observations, abdominal findings and laboratory markers, and avoid medicines that increase toxic-dilatation risk.
Agree rescue eligibility and surgical thresholds with the patient and colorectal team before the patient becomes too unwell for a balanced decision.
I will document the daily response criteria and who will make the rescue-versus-surgery decision.
What must remain explicit.
- Follow the current local ASUC pathway and 2025 BSG guidance.
- Involve colorectal surgery early.
- Escalate new distension, tenderness, systemic deterioration or rising lactate immediately.
Where reasoning fails.
- Delayed surgical referral
- No predefined reassessment point
- Ignoring thrombosis and infection risk
ASUC with stool frequency [trend], observations/abdomen [trend], inflammatory and haemoglobin markers [trend], infection results [status], treatment [response] and rescue/surgical decision [time/owner].
Does your admission template force documentation of the rescue decision point?