WBR0568

Author	[[PageAuthor::Yazan Daaboul, M.D., (Reviewed by Alison Leibowitz [1] and Yazan Daaboul, M.D.)]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Pathology
Sub Category	SubCategory::Gastrointestinal
Prompt	[[Prompt::A 27-year-old man presents to the physician's office for persistent watery diarrhea of 2 weeks duration, abdominal pain, and recent unintentional weight loss. Physical examination is remarkable for skin pallor and diffuse abdominal tenderness. Following appropriate work-up, the patient undergoes GI endoscopy that demonstrates transmural granulomatous inflammation with cobblestone mucosa and skip lesions in the small intestine. Which of the following additional findings is most likely present in this patient?]]
Answer A	AnswerA::Loss of haustra
Answer A Explanation	[[AnswerAExp::Loss of haustra is frequently observed in patients with ulcerative colitis.]]
Answer B	AnswerB::Sclerosing cholangitis
Answer B Explanation	[[AnswerBExp::Sclerosing cholangitis is a complication more frequently associated with ulcerative colitis.]]
Answer C	AnswerC::Pseudopolyps
Answer C Explanation	AnswerCExp::Pseudopolyps are a common finding in ulcerative colitis.
Answer D	AnswerD::Proctitis
Answer D Explanation	[[AnswerDExp::Proctitis may be present in Crohn's disease, but is more frequently observed in patients with ulcerative colitis.]]
Answer E	AnswerE::Fistulas
Answer E Explanation	[[AnswerEExp::Fistulas are associated with Crohn's disease.]]
Right Answer	RightAnswer::E
Explanation	[[Explanation::Inflammatory bowel disease (IBD) is classified as either Crohn's disease or ulcerative colitis. Distinction between the two conditions is made by the microscopic appearance of sample biopies, but other factors such as clinical symptoms, associated complications, and extraintestinal manifestations can also be helpful. Crohn's disease is characterized by the presence of transmural granulomatous inflammation with cobblestone mucosa and skip lesions that may manifest in virtually any part of the GI tract. Crohn's disease is associated with strictures, fistulas, perianal disease, and extraintestinal symptoms, such as migratoy polyarthritis, skin lesions, such as erythema nodosum and pyoderma gangrenosum, and kidney stones. Patients typically present with watery diarrhea. In contrast, ulcerative colitis is often characterized by continuous mucosal and submucosal inflammation that involves the rectum. Ulcerative colitis typically demonstrates friable mucosal pseudopolyps, loss of haustra in the colon, crypt abscesses, and ulcers. Unlike Crohn's disease, ulcerative colitis is usually confined to the colon, except in the case of backwash ileitis where the distal ileum is also involved. Presence of bloody diarrhea is more common among patients with ulcerative colitis. While both diseases are associated with an increased risk in the development of colorectal cancer, ulcerative colitis poses a much greater risk than Crohn's disease. Educational Objective: Crohn's disease is characterized by transmural inflammation with a cobblestone appearance and skip lesions in the GI tract. It is associated with the formation of fistulas. References: Fiocchi C. Inflammatory bowel disease: etiology and pathogenesis. Gastroenterology. 1998;115(1):182-205. First Aid 2014 page 354]]
Approved	Approved::Yes
Keyword	WBRKeyword::Crohn's Disease, WBRKeyword::Inflammatory Bowel Disease, WBRKeyword::Ulcerative Colitis, WBRKeyword::Fistulas, WBRKeyword::Transmural, WBRKeyword::Inflammation, WBRKeyword::Diarrhea, WBRKeyword::Abdominal Pain, WBRKeyword::Weight Loss, WBRKeyword::Malabsorption, WBRKeyword::Stricture, WBRKeyword::Perianal Disease, WBRKeyword::Excretory System, WBRKeyword::GI Tract
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