Inflammatory bowel disease: The Daily PANCE Blueprint

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Inflammatory bowel disease: The Daily PANCE Blueprint

A 28-year-old female presents with a 3-month history of intermittent abdominal pain, non-bloody diarrhea, weight loss, and fatigue. Physical exam reveals mild tenderness in the right lower quadrant. Laboratory studies show mild anemia and elevated C-reactive protein. Colonoscopy reveals patchy areas of inflammation with aphthous ulcers in the terminal ileum and ascending colon, with intervening normal mucosa. Biopsies show transmural inflammation and non-caseating granulomas. Which of the following is the most likely diagnosis?

A. Ulcerative colitis
B. Crohn’s disease
C. Irritable bowel syndrome
D. Ischemic colitis
E. Microscopic colitis

Answer and topic summary

The answer is B. Crohn’s disease

Inflammatory bowel disease includes two distinct entities: ulcerative colitis and crohn disease; both are immune-mediated inflammatory responses. The pathophysiology is not well known, many suspect there are genetic and environmental components. Crohn’s disease is characterized by transmural inflammation, skip lesions (patchy involvement), and granuloma formation, and can affect any part of the gastrointestinal tract, most commonly the terminal ileum and colon. Ulcerative colitis typically presents with continuous mucosal inflammation starting at the rectum and extending proximally, without skip lesions or transmural involvement. Below is a table to help you with the differences between the two. Endoscopy with biopsy is required to diagnose both of these.

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Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint GI and Nutrition ⇒ Colorectal disorders (PEARLS) ⇒ Inflammatory bowel disease

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