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* q6. 37yo w/ vomits,constip, abd cramps & swelling
 #626051  
  monicab - 10/28/11 11:50
 
  n4b1q6

A 37-year-old man comes to the physician 12 hours after the onset of vomiting and abdominal cramps and swelling. He has had constipation for the past 4 days. He was diagnosed with Crohn disease 7 years ago. His symptoms of diarrhea and right lower quadrant abdominal pain have been well controlled with mesalamine for the past 3 years. His temperature is 36C (96.8F), pulse is 98/min and regular, and blood pressure is 110/70 mm Hg. Examination shows a diffusely distended, tympanitic abdomen and visible peristalsis; high-pitched bowel sounds are heard. Rectal examination shows no stool in the rectal vault. An x-ray of the abdomen shows a small-bowel obstruction. Which of the following is the most likely cause of these findings?
A) Colon cancer
B) Ileocecal fistula
C) Small-bowel adhesions
D) Small-bowel fibrotic stricture
E) Small-bowel intussusception
 
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* Re:q6. 37yo w/ vomits,constip, abd cramps & swelli
#2512272
  monicab - 10/28/11 12:12
 
  Crohn Disease:
==========

ASCA +
After 8 years of disease Colonoscopy screening ever year for Colon Ca
Skip lesions
Transmural granulomas
Fistulas and abscesses
masses and obstructions
perianal disease

Extensive inflammation may result in hypertrophy of the muscularis mucosae, FIBROSIS and STRICTURE formation, which leasd to bowel OBSTRUCTION. Stenotic segments cause bowel obstruction, with colicky pain, distention, obstipation, and vomiting.

Crohn's disease presents 3 principal patterns:
(1) primarily inflammatory, which after several years commonly evolves into either
(2) primarily stenotic or obstructing or
(3) primarily penetrating or fistulizing.

These different clinical patterns dictate different therapeutic approaches.


Based on the information I would go with

D) Small-bowel fibrotic stricture
 
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* Re:q6. 37yo w/ vomits,constip, abd cramps & swelli
#2512276
  4usmlee - 10/28/11 12:18
 
  Ans is D  
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* Re:q6. 37yo w/ vomits,constip, abd cramps & swelli
#2512313
  sonia29 - 10/28/11 13:00
 
  dd)complication of chron disease  
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