Ulcerative colitis physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Usama Talib, BSc, MD [2]

Ulcerative colitis shows intestinal and extra intestinal findings on physical examination. These include abdominal tenderness, fever, pallor, inflammation of the iris and uvea, skin rash, inflammation of the joints, aphthous ulcers and clubbing of the fingers.^[1][2]

As ulcerative colitis is a systemic disease, patients may present with symptoms and complications outside the colon. These include the following:^{[1][3][4][5][6]}

• Normal appearance in mild disease
• Pallor may be noticed

• Fever
• Tachycardia
• Hypotension

• Normal in mild disease
• Abdominal tenderness when palpated in severe disease
• Blood seen on rectal exam

The ophthalmic physical exam findings may include:

• Iritis or uveitis, which is inflammation of the iris
• Episcleritis

• Seronegative arthritis, which can be a large-joint oligoarthritis (affecting one or two joints), or may affect many small joints of the hands and feet
• Ankylosing spondylitis, arthritis of the spine
• Sacroiliitis, arthritis of the lower spine

• Erythema nodosum, which is a panniculitis, or inflammation of subcutaneous tissue involving the lower extremities
• Pyoderma gangrenosum, which is a painful ulcerating lesion involving the skin

• Deep venous thrombosis and pulmonary embolism
• Autoimmune hemolytic anemia
• Clubbing, a deformity of the ends of the fingers
• Primary sclerosing cholangitis, or inflammation of the bile ducts
• Aphthous ulcers of the mouth

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