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Old 10-09-2012
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Arrow Billy Step 1 Questions # 20

A 49-year-old woman sees her physician because she has had abdominal cramps and diarrhea with six stools per day
for the past month. She has a history of similar episodes of self-limited pain and diarrhea, which have occurred several
times during the past 20 years. Each episode lasts about 2 weeks and resolves without treatment. Findings on physical
examination are unremarkable, but a stool sample is positive for occult blood. Laboratory studies show no ova or parasites
in the stool. Colonoscopy shows diffuse and uninterrupted mucosal inflammation and superficial ulceration extending from
the rectum to the ascending colon. Colonic biopsy specimens from the area show a diffuse, predominantly mononuclear
infiltrate in the lamina propria. The patient is at high risk of developing which of the following complications?


□ (A) Adenocarcinoma of the colon
□ (B) Diverticulitis
□ (C) Primary biliary cirrhosis
□ (D) Fat malabsorption
□ (E) Pseudomembranous colitis
□ (F) Perirectal fistula formation
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Old 10-09-2012
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So she had IBS and developed Ulc.colitis in last months
itself IBS it's not associated with colon CA, but UC is and presentation looks like UC. will go with A
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Last edited by beka-CTS; 10-09-2012 at 08:28 AM. Reason: Changed answer ;)
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Old 10-09-2012
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a) adenocarcinoma of colon....???

from ulcerative colitis

thanks
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  #4  
Old 10-09-2012
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Default my answer :)

(A) Adenocarcinoma of the colon - this pt has UC
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Old 10-09-2012
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ulcerative colitis======adeno ca colon
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Old 10-09-2012
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A) adenoCa colon ..

Features of AdnCa colon post-UC(from UW) add more points guys
-Sessile,
-Multicenteic,
-Early P53 mutation
-
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Old 10-09-2012
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Correct Answer A is correct

This patient has clinical and histologic features of ulcerative colitis. Particularly important are relapsing and
remitting episodes of diarrhea containing blood and mucus and diffuse inflammation and ulceration of the rectal and
colonic mucosa. One of the most dreaded complications of ulcerative colitis is the development of colonic
adenocarcinoma. There is a 20-fold to 30-fold higher risk in patients who have had ulcerative colitis for 10 or more years
compared with control populations. Diverticulitis can produce abdominal pain and blood in the stool, but there is no
association with ulcerative colitis. Ulcerative colitis is associated with several extraintestinal manifestations, including
sclerosing cholangitis, but it has no relationship to primary biliary cirrhosis. Fat malabsorption usually does not occur in
ulcerative colitis because the ileum often is not involved. Pseudomembranous colitis is caused by Clostridium difficile
infections associated with antibiotic treatment. Perirectal fistula formation is more typical of Crohn's disease, in which there
is transmural inflammation
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