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{{WBRQuestion
{{WBRQuestion
|QuestionAuthor={{Rim}}, {{AJL}} {{Alison}}
|QuestionAuthor={{YD}}, (Reviewed by {{AJL}} and {{YD}})
|ExamType=USMLE Step 1
|ExamType=USMLE Step 1
|MainCategory=Pathology
|MainCategory=Pathology
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|MainCategory=Pathology
|MainCategory=Pathology
|SubCategory=Gastrointestinal
|SubCategory=Gastrointestinal
|Prompt=A 27-year-old male presents to the physician's office for persistent watery diarrhea of several days duration, abdominal pain, and unintentional weight loss. Upon physical examination you observe skin pallor and 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?
|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?
|Explanation=Inflammatory bowel disease (IBD) is divided into [[Crohn's disease]] and [[ulcerative colitis]]. Differention between the conditions is based upon clinical symptoms, gross morphology of the GI tract, microscopic appearance, associated complications, extraintestinal manifestations, and treatment.
|Explanation=Inflammatory bowel disease (IBD) is classified as either [[Crohn's disease]] or[[ulcerative colitis]]. Differention between the two conditions is based upon clinical symptoms, gross morphology of the GI tract, microscopic appearance, associated complications, and extraintestinal manifestations. [[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 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.
 
[[Crohn's disease]] is characterized by the presence of transmural granulomatous inflammation, with cobblestone mucosa and skip lesions manifesting in any part of the GI tract. [[Ulcerative colitis]] is often characterized by continuous inflammation, involving the the rectum and infrequently involving the GI tract with the exception of the colon (except in the case of backwash ileitis).  [[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, but bloody diarrhea may also manifest.
 
[[Ulcerative colitis]] is characterized by mucosal and submucosal inflammation, only with friable mucosal pseudopolyps and loss of haustra, crypt abscesses, and ulcers. Patients typically present with bloody diarrhea.
|AnswerA=Loss of haustra
|AnswerA=Loss of haustra
|AnswerAExp=Loss of haustra is frequently observed in patients with [[ulcerative colitis]].
|AnswerAExp=Loss of haustra is frequently observed in patients with [[ulcerative colitis]].
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|AnswerE=Fistulas
|AnswerE=Fistulas
|AnswerEExp=Fistulas are associated with [[Crohn's disease]].
|AnswerEExp=Fistulas are associated with [[Crohn's disease]].
|EducationalObjectives=[[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.
|EducationalObjectives=[[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=First Aid 2014 page 354
|References=Fiocchi C. Inflammatory bowel disease: etiology and pathogenesis. Gastroenterology. 1998;115(1):182-205.<br>
First Aid 2014 page 354
|RightAnswer=E
|RightAnswer=E
|WBRKeyword=Crohn's Disease, Inflammatory Bowel Disease, Ulcerative Colitis, Fistulas, Transmural, Inflammation, Diarrhea, Abdominal Pain, Weight Loss, Malabsorption, Stricture, Perianal Disease, Excretory System, GI Tract
|WBRKeyword=Crohn's Disease, Inflammatory Bowel Disease, Ulcerative Colitis, Fistulas, Transmural, Inflammation, Diarrhea, Abdominal Pain, Weight Loss, Malabsorption, Stricture, Perianal Disease, Excretory System, GI Tract
|Approved=Yes
|Approved=Yes
}}
}}

Revision as of 15:54, 13 October 2014
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 orulcerative colitis. Differention between the two conditions is based upon clinical symptoms, gross morphology of the GI tract, microscopic appearance, associated complications, and extraintestinal manifestations. 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 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
Linked Question Linked::
Order in Linked Questions LinkedOrder::
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