Crohn's Disease vs Ulcerative Colitis
Both are inflammatory bowel disease, both cause chronic diarrhea, and both show up in young adults — but the NCLEX expects you to know exactly which one causes fistulas and which one causes bloody mucoid stools. Picking the wrong complication or telling a client surgery will cure Crohn's is a missed question every time.
Side-by-side comparison
- Transmural — full bowel-wall thickness
- Mouth to anus; skip lesions, terminal ileum
- Continuous inflammation, no skip areas
- Rectum & colon only; mucosal/submucosal
- Semi-formed non-bloody stool; RLQ pain
- Steatorrhea, weight loss, malabsorption
- ★Bloody diarrhea with mucus
- 10–20 stools/day; LLQ cramping, tenesmus
- ★Cobblestone mucosa on endoscopy
- Deep linear ulcers, skip pattern
- Pseudopolyps, friable mucosa
- Continuous erythema from rectum
- Monitor malabsorption, weight loss; replace B12
- Low-residue diet in flares; TPN if severe
- Watch toxic megacolon: distension, fever
- Hold anticholinergics/antidiarrheals; track blood
- Biologics (infliximab) first-line; immunomodulators
- Metronidazole/cipro for fistulizing disease
- 5-ASA (mesalamine, sulfasalazine) first-line
- Biologics if moderate–severe
- ★Surgery is palliative, NOT curative
- Disease recurs at the anastomosis
- ★Colectomy is curative
- Annual colonoscopy after 8–10 years
- Fistula, abscess, or bowel obstruction
- Toxic megacolon: distension + fever
- Severe hemorrhage
- Fistulas, strictures → obstruction
- Oxalate stones, gallstones; malabsorption
- Toxic megacolon, severe hemorrhage
- Colorectal cancer risk ↑; PSC
Crohn's Disease
- Transmural — full bowel-wall thickness
- Mouth to anus; skip lesions, terminal ileum
Ulcerative Colitis
- Continuous inflammation, no skip areas
- Rectum & colon only; mucosal/submucosal
Crohn's Disease
- Semi-formed non-bloody stool; RLQ pain
- Steatorrhea, weight loss, malabsorption
Ulcerative Colitis
- ★Bloody diarrhea with mucus
- 10–20 stools/day; LLQ cramping, tenesmus
Crohn's Disease
- ★Cobblestone mucosa on endoscopy
- Deep linear ulcers, skip pattern
Ulcerative Colitis
- Pseudopolyps, friable mucosa
- Continuous erythema from rectum
Crohn's Disease
- Monitor malabsorption, weight loss; replace B12
- Low-residue diet in flares; TPN if severe
Ulcerative Colitis
- Watch toxic megacolon: distension, fever
- Hold anticholinergics/antidiarrheals; track blood
Crohn's Disease
- Biologics (infliximab) first-line; immunomodulators
- Metronidazole/cipro for fistulizing disease
Ulcerative Colitis
- 5-ASA (mesalamine, sulfasalazine) first-line
- Biologics if moderate–severe
Crohn's Disease
- ★Surgery is palliative, NOT curative
- Disease recurs at the anastomosis
Ulcerative Colitis
- ★Colectomy is curative
- Annual colonoscopy after 8–10 years
Crohn's Disease
- Fistula, abscess, or bowel obstruction
Ulcerative Colitis
- Toxic megacolon: distension + fever
- Severe hemorrhage
Crohn's Disease
- Fistulas, strictures → obstruction
- Oxalate stones, gallstones; malabsorption
Ulcerative Colitis
- Toxic megacolon, severe hemorrhage
- Colorectal cancer risk ↑; PSC
★ marks the fact that sets a column apart.
Clinical Pearl
Crohn's CROWDs the whole tract with fistulas; UC is Uniformly Continuous, bloody, and Curable by colectomy.
Play this as a game — free
Drill Crohn's Disease vs Ulcerative Colitis in Swipe Right & Speed Sort. 14-day free trial, no card required.