WBR0568

Author	[[PageAuthor::Rim Halaby, M.D. [1]]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Pathology
Sub Category	SubCategory::Gastrointestinal
Prompt	[[Prompt::A 27 year old man with no previous past medical history presents to the physician's office for persistent watery diarrhea of several days duration associated with abdominal pain and unintentional weight loss. The patient denies smoking or alcohol use. He has no recent intake of medications of known allergies. Physical examination is remarkable for abdominal tenderness and pallor. Following appropriate work-up, the patient undergoes GI endoscopy that shows transmural granulomatous inflammation with cobblestone mucosa and skip lesions in the small intestine. Which of the following additional findings is most likely to be present in this patient?]]
Answer A	AnswerA::Loss of haustra
Answer A Explanation	AnswerAExp::Loss of haustra is seen in patients with ulcerative colitis.
Answer B	AnswerB::Sclerosing cholangitis
Answer B Explanation	AnswerBExp::Sclerosing cholangitis is a complication associated with ulcerative colitis. Nonetheless, it may be present in Crohn's disease.
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 mostly 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. Differences between the two is based on clinical symptoms, gross morphology of the GI tract, microscopic appearance, and associated complications extraintestinal manifestations, and treatment. Crohn's disease is characterized by the presence of transmural granulomatous inflammation with cobblestone mucosa and skip lesions that may be present in virtually any part of the GI tract. In contrast, ulcerative colitis is often described as continuous inflammation that involves the rectum and almost never involves the tract except 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 is also observed. Ulcerative colitis is characterized by mucosal and submucosal inflammation only with friable mucosal pseudopolyps and loss of haustra. It is associated with crypt abscesses and ulcers. Patients typically present with bloody diarrhea. Educational Objective: Crohn's disease is characterized by transmural inflammation with cobblestone appearance and skip lesions in any part of the GI tract. It is associated with formation of fistulas. Educational Objective: References: ]]
Approved	Approved::No
Keyword	WBRKeyword::crohn's, WBRKeyword::crohn, WBRKeyword::Crohn's, WBRKeyword::Crohn, WBRKeyword::inflammatory, WBRKeyword::bowel, WBRKeyword::disease, WBRKeyword::inflammatory bowel disease, WBRKeyword::ulcerative, WBRKeyword::colitis, WBRKeyword::ulcerative colitis, WBRKeyword::fistula, WBRKeyword::fistulas, WBRKeyword::transmural, WBRKeyword::inflammation, WBRKeyword::diarrhea, WBRKeyword::watery, WBRKeyword::bloody, WBRKeyword::abdominal, WBRKeyword::pain, WBRKeyword::abdominal pain, WBRKeyword::weight loss, WBRKeyword::weight loss, WBRKeyword::malabsorption, WBRKeyword::stricture, WBRKeyword::strictures, WBRKeyword::perianal disease, WBRKeyword::crypt, WBRKeyword::abscess, WBRKeyword::abscesses, WBRKeyword::sclerosing, WBRKeyword::cholangitis
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::