A 25-year-old man comes to the emergency department due to a 3-month history of abdominal pain and diarrhea. Bowel movements occur 3 or 4 times a day, and he has occasionally noticed blood in his stool. The patient has no fever but displays "low energy." He was diagnosed with anterior uveitis 3 years ago but has no other medical problems and takes no medications. His parents and 2 siblings are alive and healthy. Vital signs are normal. Abdomen is tender and bowel sounds are hyperactive. The perianal area appears normal. Laboratory results show anemia and an elevated erythrocyte sedimentation rate. Which of the following features would most favor the diagnosis of Crohn disease compared with ulcerative colitis?

Question

A 25-year-old man comes to the emergency department due to a 3-month history of abdominal pain and diarrhea.  Bowel movements occur 3 or 4 times a day, and he has occasionally noticed blood in his stool.  The patient has no fever but displays "low energy."  He was diagnosed with anterior uveitis 3 years ago but has no other medical problems and takes no medications.  His parents and 2 siblings are alive and healthy.  Vital signs are normal.  Abdomen is tender and bowel sounds are hyperactive.  The perianal area appears normal.  Laboratory results show anemia and an elevated erythrocyte sedimentation rate.  Which of the following features would most favor the diagnosis of Crohn disease compared with ulcerative colitis?

Quizplus · Accepted Answer

Explanation: 11ec25c8_d3f5_05aa_bc81_d117ded7c977_MD0003_00 Inflammatory bowel disease is characterized by idiopathic and chronic gastrointestinal (GI) inflammation, and the 2 major types are ulcerative colitis (UC) and Crohn disease (CD). Several features are more suggestive of CD than UC and are helpful in differentiating between the 2 conditions: Involvement of multiple portions of the GI tract (extending from the mouth to the anus) Presence of noncaseating granulomas (up to 30% of patients with CD) Rectal sparing (Choice D) Fistula formation Other characteristic features of CD are transmural involvement of the colon, skip lesions (disease-free regions of GI tract), cobblestone appearance of the colon, fissures, abscesses, and perianal disease (Choice A). Conversely, UC is more commonly characterized by bloody diarrhea and continuous involvement of the rectum and colon (Choices B and C). Endoscopic evaluation (eg, colonoscopy) is central to diagnosis of both CD and UC and frequently helpful in distinguishing them from each other. Initial management of both CD and UC involves administration of 5-aminosalicylic acids and, frequently, corticosteroids. Maintenance therapy for both diseases may involve azathioprine or antitumor necrosis factors. (Choice E) Pseudopolyps are growths due to chronic inflammatory disease. These are more commonly seen in UC but frequently seen in CD. Educational objective: A number of features are helpful in differentiating ulcerative colitis (UC) and Crohn disease (CD), including involvement of multiple portions of the gastrointestinal tract, rectal sparing, presence of noncaseating granulomas, and fistula formation, all of which are more suggestive of CD than UC. References: Diagnosis and management of Crohn's disease. (http://www.ncbi.nlm.nih.gov/pubmed/22230271) Ulcerative colitis. (http://www.ncbi.nlm.nih.gov/pubmed/23939448)

A 25-Year-Old Man Comes to the Emergency Department Due to a 3-Month