Is this Ulcerative Colitis or Crohn's? - USMLE Forums
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  #1  
Old 02-27-2012
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GIT Is this Ulcerative Colitis or Crohn's?

A 33-year-old man presents as a new patient to a primary care physician. He tells the physician that he has had almost constant abdominal pain for at least the past month, and he lost his appetite and about 15 pounds during the past month; he also complains of being fatigued almost all the time. In addition, he has had frequent bouts of bloody diarrhea and the diarrhea and the concomitant need to wipe his bottom left his rectum sore. He adds that he had a similar sequence of events about 5 years previously, and at that time, his physician told him he had a nervous stomach. He adds that his younger brother seems to be having similar problems. The physician notes that he looks pale, and upon examination, she finds he has diffuse abdominal tenderness with the right lower quadrant being the most sensitive area. His temperature is 99.5F (37.5C), blood pressure 98/78 mm Hg, pulse 90 and regular; a complete blood count reveals that his serum hemoglobin value is 9.8 g/dL and a peripheral blood smear reveals a decreased mean corpuscular hemoglobin
count (MCHC) and a decreased mean corpuscular volume (MCV).
Among the following choices, which most likely represents the disease that this man suffers from?
(A) Crohn’s disease
(B) Ulcerative colitis
(C) Irritable bowel syndrome
(D) Lactase deficiency
(E) Nervous stomach

Please give reason
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  #2  
Old 02-27-2012
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Crohn's disease.
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  #3  
Old 02-27-2012
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please give reason
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  #4  
Old 02-27-2012
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Crohn's disease...

the concomitant need to wipe his bottom may be caused by a fistula...

which only occurs in crohn's due to granulomas and transmural inflammation as opposed to UC which only has mucosal inflammation
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Old 02-27-2012
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chronic+RLQ pain ( involves Ileum )+diarrhea+weight loss = CD
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  #6  
Old 02-27-2012
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abdominal pain+diarrhea+fever= inflammatory bowel disease.... now right lower quadrant pain points towards crohns disease bt bloody diarrhea is more in favor of ulcerative colitis.... bt the need to constantly wipe his bottom means a fistula... which is seen on CD.... so i thnk its crohns disease...
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Default crohns disease

reason being the pain more severe in the right lower quadrant plus the early recurrence and the need to wipe out the bottom again and again indicating fistula formation
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Old 02-27-2012
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I would say UC
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Old 02-27-2012
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He has got what's known as Crohn's colitis. This is Crohn's disease affecting the colon. Recall that Crohn's can affect any part of the GIT. You can have Crohn's disease which is limited to colonic or rectal involvement leading to Crohn's colitis which many people may confuse with ulcerative colitis. The diffuse abdo pain and RIF pain on examination is indicative of Crohn's, and as has been previously mentioned, the constant wiping also suggests a fistula. Finally, he is fatigued which is probably due to anemia. This can be due to blood loss from the more extensive involvement of the GIT in Crohns over UC (however one could argue UC could produce just as profound an iron deficiency anemia as Crohns), but more indicative of Crohns, is that they often have a macrocytic anemia due to B12 malabsorption from ileal disease! And the question stated he has RIF pain, so ileal disease is bang on the money
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Oh crap, I misread the anemia as macrocytic! Stupid me! Well even considering he has a microcytic anemia I'm still going for crohn's colitis for the other reasons I specified above.
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  #11  
Old 02-28-2012
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ans is crohns disease
RLQ+fistula

thats ans in buk
sounds okay to me.

by the way, both uc and crohns can have microcytic anemia. they both bleed..though megaloblastic is a clue to crohns.
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  #12  
Old 02-28-2012
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A.) crohn disease
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Gastroenterology-, Internal-Medicine-, Step-2-Questions

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