Digital Library: Case Studies: The Gastrointestinal Tract: Case 3: Inflammatory Bowl Disease 25-year old woman with bloody diarrhea. Chief complaint: Persistent bloody diarrhea for four weeks prior to admission associated with abdominal cramps and fatigue. Physical examination: Acutely ill patient with dry skin and mucous membranes. The abdomen was tender with mild abdominal distension. Bowel sounds were diminished. No masses were palpable. Colonoscopy: Colonoscopy revealed friable, ulcerated mucosa beginning in the rectum and extending continuously into the right colon. Laboratory data: Stool cultures were negative for pathogens and examination was negative for ova and parasites. Assay for C. difficile toxin was negative. Macroscopic appearance of the proctocolectomy specimen (rectum in center). Describe the appearance and distribution of the abnormality. The diagnosis of ulcerative colitis. Erythematous, friable ulcerated mucosa begins in the rectum and extends continuously to involve about one-half of the colorectum. The remainder of the colonic mucosa is normal. The macroscopic features are typical for ulcerative colitis. Close-up view of the colon of another patient with the same disorder. The islands of red tissue represent polypoid foci of residual inflamed mucosa (inflammatory polyps) sitting adjacent to shiny, tan ulcerated bowel wall, which has been denuded of its mucosa. Another example of a colon involved with this disorder. Note numerous inflammatory polyps. Sometimes these can be so striking that macroscopically the pathologist can mistake it for familial adenomatous polyposis. Compare and contrast the macroscopic features in these two colectomy specimens with that of those seen previously. The diagnosis is Crohn disease. This shortened colon (first image) demonstrates discontinous ulceration with intervening normal mucosa (skip lesions). The cecal region is markedly thickened, representing an inflammatory stricture. The colon (second image) details the appearance of so-called "rake ulcers", parallel linear ulcers sometimes seen in Crohn disease. Question for Class Discussion Define the following terms: ulcer, abscess, polyp, and granuloma. First Name: (required; no spaces) Last Name: (required; no spaces)