WBR0568
| Author | [[PageAuthor::Rim Halaby, M.D. [1], Alison Leibowitz [2] (Reviewed by Alison Leibowitz)]] |
|---|---|
| Exam Type | ExamType::USMLE Step 1 |
| Main Category | MainCategory::Pathology |
| Sub Category | SubCategory::Gastrointestinal |
| Prompt | [[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?]] |
| 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 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.
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. |
| 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:: |