A 34-year-old male presents to the clinic with a 3-month history of increasing abdominal discomfort, diarrhea, and occasional blood in his stools. He reports that the diarrhea occurs about 5–6 times a day and is associated with urgency, especially in the mornings. He mentions that he has had some weight loss of about 4-5 kilograms in the last 2 months and has been feeling fatigued. He denies any fever, but he does note a slight increase in joint pain, particularly in his knees.

The patient has a history of intermittent abdominal pain and diarrhea over the past year, but it has become more frequent and severe recently. He has no significant past medical history of inflammatory bowel disease (IBD) in the family.

On examination, the patient appears well-nourished but mildly pale. There is mild tenderness to palpation in the left lower quadrant of the abdomen. No palpable masses are noted, and there is no significant hepatosplenomegaly. A digital rectal exam reveals bright red blood on the glove, consistent with rectal bleeding.

Routine blood tests show mild anemia (hemoglobin 10.5 g/dL) and elevated C-reactive protein (CRP), indicating some systemic inflammation. Stool cultures for infections are negative.

A colonoscopy is scheduled, which shows continuous inflammation of the mucosa starting from the rectum and extending proximally, with areas of ulceration and loss of vascular pattern. Biopsy results confirm the diagnosis of Ulcerative Colitis, with inflammation limited to the mucosa and submucosa.

Diagnosis: Ulcerative Colitis (moderate).

Management Plan:

• Initiate 5-aminosalicylic acid (5-ASA) therapy to reduce inflammation.

• Consider corticosteroids for flare-ups.

• Refer for follow-up with gastroenterology and a dietitian for symptom management.

• Advise on the importance of monitoring for complications, including colorectal cancer.