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. 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: 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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