Review Question - QID 107179

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Crohn Disease Studies Invasive studies QID: 107179 (M2.GI.15.4672)

QID 107179 (Type "107179" in App Search)

A 25-year-old woman presents to her primary care physician complaining of several months of diarrhea. She has also had crampy abdominal pain. She has tried modifying her diet without improvement. She has many watery, non-bloody bowel movements per day. She also reports feeling fatigued. The patient has not recently traveled outside of the country. She has lost 10 pounds since her visit last year, and her BMI is now 20. On exam, she has skin tags and an anal fissure. Which of the following would most likely be seen on endoscopy and biopsy?

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Diffuse, non-focal ulcerations with granuloma

29%

28/98

Diffuse, non-focal ulcerations without granuloma

17%

17/98

Pseudopolyps and continuous mucosal involvement

18%

18/98

Focal ulcerations with granuloma

28%

27/98

Friable mucosa with pinpoint hemorrhages

6/98

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Symptoms of Crohn's disease (CD) usually are non-bloody diarrhea, fatigue, crampy abdominal pain, and weight loss; as compared to ulcerative colitis (UC), endoscopy in CD will show focal lesions, with or without the presence of granuloma.

CD is an inflammatory bowel disease characterized by inflammation of the GI tract with subsequent tissue damage. CD may involve any portion of the GI tract, with the terminal ileum being the single most common area of involvement. Risk factors include Caucasian race or Ashkenazi Jewish heritage, or a positive family history. CD most often presents in the 20's but frequently also first manifests in adolescence. Symptoms include non-bloody diarrhea, malaise, fever,abdominal pain, and cramps. While diarrhea can occasionally have blood in CD, diarrhea in UC usually has blood; thus, the absence of blood suggests CD over UC.

Illustration A shows a histological image of a granuloma in a biopsy from a CD patient. Illustration B shows an endoscopic image of severe pseudopolyp proliferation in UC.

Incorrect Answers:
Answers 1-3: Diffuse ulcerations are seen in UC, not CD. Pseudopolyps can be seen in UC or CD, but continuous mucosal involvement is seen in UC.
Answer 5: Friable mucosa and pinpoint hemorrhages are seen in UC.

ILLUSTRATIONS:

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