Ulcerative colitis usually presents with which of the following?

• A. Bloody diarrhea
• B. Toxic megacolon
• C. Fever and left quadrant pain
• D. Alternating constipation and diarrhea

Answer: (A)

Bloody diarrhea is the hallmark presentation of ulcerative colitis. This condition involves inflammation that is limited to the mucosa of the colon and typically starts in the rectum, spreading continuously. The superficial ulcers bleed, so the stool often contains blood along with increased frequency and urgency. While fever and abdominal pain can occur during severe flares and toxic megacolon is a serious complication, these are not the usual presenting features. Alternating constipation and diarrhea is more characteristic of other conditions such as irritable bowel syndrome. So the most typical initial sign is blood in the stool with diarrhea.