Inflammatory Bowel Disease

Chapter 37 Inflammatory Bowel Disease




Clinical Case Problem 1: A 32-Year-Old Woman with Fever, Weight Loss, and Chronic Diarrhea


A 32-year-old woman comes to your office with a 6-month history of loose bowel movements, approximately eight per day. Blood has been present in many of them. She has lost 30 pounds. For the past 6   weeks, she has had an intermittent fever. She has had no previous gastrointestinal (GI) problems, and there is no family history of GI problems.


On examination, the patient looks ill. Her blood pressure is 130/70   mm Hg. Her pulse is 108 beats/minute and regular. There is generalized abdominal tenderness with no rebound.


A sigmoidoscopy reveals a friable rectal mucosa with multiple bleeding points.



Select the best answer to the following questions




1. What is the most likely diagnosis in this patient?


a. irritable bowel syndrome

b. Crohn disease

c. ulcerative colitis

d. Crohn colitis

e. bacterial dysentery

2. At this time, which of the following represent(s) the investigation(s) of choice?


a. colonoscopy

b. barium enema

c. upper GI series and follow-through

d. a and c

e. a, b, and c

3. Which of the following may be indicated in the management of the acute phase of the condition described?


a. steroid enemas

b. oral corticosteroids

c. parenteral corticosteroids

d. a and b

e. a, b, and c

4. Which of the following statements regarding the use of sulfasalazine in the condition described is (are) false?


a. sulfasalazine is structurally related to both aspirin and sulfa drugs

b. sulfasalazine is effective in maintaining remission in this condition and in the acute treatment of mild disease

c. sulfasalazine may impair folic acid metabolism

d. all of the above

5. Which of the following statements regarding the long-term prognosis of the patient described in the case history is false? Following an initial attack …


a. 66% of patients go into remission with medical therapy

b. 80% of treatment-compliant patients maintain remission for many years

c. 10% of patients continue to have active disease until surgical intervention is undertaken

d. 5% of patients die within a year

e. none of the above is false

6. Which of the following complications occur(s) in the disease described?


a. toxic megacolon and strictures

b. colonic cancer

c. iritis

d. a and b

e. a, b, and c


Clinical Case Problem 2: A 25-Year-Old Man Presents with an 18-Month History of Chronic Abdominal Pain


A 25-year-old man presents with an 18-month history of chronic abdominal pain. The patient has seen several physicians and has been diagnosed as having “nervous stomach,” irritable bowel syndrome, and “depression.” Associated with this abdominal pain for the past 3   months have been nonbloody diarrhea, anorexia, and a weight loss of 20 pounds. He has developed a painful area around the anus.


On examination, the patient has diffuse abdominal tenderness. He looks thin and unwell. He has a tender, erythematous area in the right perirectal area.



7. What is the most likely diagnosis?


a. irritable bowel syndrome

b. Crohn disease

c. ulcerative colitis

d. bacterial dysentery

e. amebiasis

8. Pathologically, what is the difference between the patient in this case and the patient described in Clinical Case Problem 1?


a. inflammation in this case involves all layers of the bowel; the former involves only the mucosa

b. inflammation in the former case involves all layers of the bowel; the latter involves only the mucosa

c. inflammation in the former case involves the first two layers of the bowel (mucosa and submucosa); the latter involves only the mucosa

d. inflammation in this case involves the first two layers of the bowel (mucosa and submucosa); the former involves only the mucosa

e. the two diseases are essentially identical on a pathophysiologic basis

9. Which of the following investigations is the most sensitive test to confirm the diagnosis in this patient?


a. sigmoidoscopy

b. colonoscopy

c. barium enema

d. computed tomography (CT) scan of the abdomen

e. magnetic resonance imaging (MRI) scan of the abdomen

10. Which of the following drugs is (are) appropriate initial therapy in the acute phase of the condition described in Clinical Case Problem 2?


a. budesonide

b. sulfasalazine

c. metronidazole

d. 6-mercaptopurine

e. all of the above

11. Metronidazole is effective in which of the following subtypes of Crohn disease?


a. mild Crohn disease

b. perianal disease

c. Crohn disease of the small bowel

d. a and b

e. a, b, and c

12. Which of the following is (are) not associated with Crohn disease?


a. skip lesions on radiograph

b. thumbprinting on radiograph

c. anti–Saccharomyces cerevisiae antibodies

d. perinuclear-staining antineutrophil cytoplasmic antibodies

e. a and c

13. Which of the following statements regarding complications of the condition described in Clinical Case Problem 2 is false?


a. rectal fissures, rectocutaneous fistulas, and perirectal abscesses are common complications of this condition

b. arthritis sometimes is seen as a complication of this condition

c. erythema nodosum and pyoderma gangrenosum sometimes are found with this condition

d. patients with this condition are not at increased risk of colorectal cancer

e. none of the above


Clinical Case Problem 3: A Thin, Anemic-Appearing 31-Year-Old Woman


A 31-year-old woman comes to your office with a 6-month history of GI problems including abdominal distention, excessive flatus, foul-smelling stools, weight loss, and nonspecific complaints of weakness and fatigue. The patient describes the symptoms as being especially severe after the intake of cereal grains and bread of any kind. The patient has not traveled to any specific area in the recent past. She has not left the country.


She is thin and looks anemic. Vital signs are normal. The patient is in no acute distress, but her abdomen reveals active bowel sounds, mild distention, and diffuse discomfort to palpation.



14. On the basis of this information, what is the most likely diagnosis in this patient?


a. lactase deficiency

b. acute pancreatitis

c. celiac sprue

d. tropical sprue

e. bacterial overgrowth syndrome

15. What is the pathophysiology of this disease?


a. immunologic disorder of the small bowel mucosa

b. disaccharide deficiency of the small intestinal mucosa

c. pancreatic exocrine deficiency

d. secondary contamination of the small intestine by coliform bacteria

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Oct 1, 2016 | Posted by in GENERAL SURGERY | Comments Off on Inflammatory Bowel Disease

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