ARJ
Forum Guru
Topics: 133
Posts: 792
|
10) A 22-year-old man is diagnosed with Crohn disease limited to the terminal ileum. His symptoms of mild right lower quadrant pain and postprandial diarrhea resolve after the initiation of treatment with mesalamine. Two years later, he develops recurrent episodes of abdominal distention, nausea, and vomiting after large meals. On two occasions, these symptoms are accompanied by inability to pass flatus or bowel movements. Which of the following has this patient most likely developed?
A. Fibrosis and a stricture in the terminal ileum
B. A fistula from the ileum to the sigmoid
C. Gastric outlet obstruction
D. An obstructing cecal carcinoma
E. An obstructing ileal carcinoid
___________________
"Live as if you were to die tomorrow. Learn as if you were to live forever." --Mahatma Gandhi
|
| GoStep2
Forum Newbie
Topics: 1
Posts: 19
|
I will go with A).
|
| phuluong2k
Forum Fanatic
Topics: 714
Posts: 2,008
|
A
|
| mani
Forum Guru
Topics: 104
Posts: 1,403
|
A. Fibrosis and a stricture in the terminal ileum causing obstruction
___________________
Sincerity and hard work are the keys to success!
|
| kabu
Forum Senior
Topics: 19
Posts: 105
|
A
|
| DrS
Forum Elite
Topics: 32
Posts: 338
|
A
|
| ARJ
Forum Guru
Topics: 133
Posts: 792
|
A. This patient with Crohn disease has developed symptoms of a small bowel obstruction, which is a common and important complication of this condition. This occurs in Crohn disease as a result of chronic transmural inflammation, which both partially destroys the normal bowel wall and constricts it with thick bands of fibrosis. Other important intestinal complications can include fistula formation and chronic abscesses. In addition, a wide variety of extraintestinal complications can include autoimmune diseases (arthritis, aphthous ulcers, erythema nodosum, pyoderma gangrenosum, eye involvement, ankylosing spondylitis primary sclerosing cholangitis) and complications related to disrupted bowel physiology (renal complications, including kidney stones and urinary tract obstruction, malabsorption, and amyloidosis secondary to longstanding inflammation).
A fistula from the ileum to the sigmoid (choice B) can develop in patients with Crohn disease but will present with symptoms of diarrhea (because of the bypass of a large portion of the colon) and not obstruction. Gastric outlet obstruction (choice C) may produce vomiting, usually of only partially digested foods, and does not usually result in significant abdominal distension. Furthermore, there is no impairment of passage of flatus or bowel movements.
Cecal carcinoma (choice D) can cause obstruction, but it would be extraordinarily rare in a 22-year-old man. Carcinoma is more likely to complicate ulcerative colitis than Crohn disease.
There is nothing in his history to suggest the development of carcinoid syndrome (choice E) in this young patient. These tumors, when they do occur, rarely present with a bowel obstruction, but may present with the carcinoid syndrome, i.e., facial flushing, diarrhea, wheezing, and tricuspid regurgitation.
___________________
"Live as if you were to die tomorrow. Learn as if you were to live forever." --Mahatma Gandhi
|
|
| |
| | | | | | | |
Similar forum topics