MEDizzy - A 33-year-old woman with Crohn disease presents with a flare

Feed Library Learning Discuss Leaderboard Journal

INFLAMMATORY BOWEL DISEASE

A 33-year-old woman with Crohn disease presents with a flare of disease activity consisting of fever, right lower quadrant pain, weight loss of more than 10% of body weight, guaiac-positive diarrhea, and macrocytic anemia. Her disease is limited to the small intestine and terminal ileum. Her examination is significant for a temperature 100.2° F (37.9° C), active bowel sounds, and right lower quadrant tenderness. Which of the following statements is true for this patient?

ExplanationThe correct answer is D. This patient has moderate to severe Crohn disease, as judged on the basis of her fever, weight loss, abdominal pain without obstruction, and ability to continue oral intake. Sulfasalazine is unlikely to deliver much anti-inflammatory activity to the small bowel because sulfasalazine is poorly hydrolyzed into its component sulfa and active salicylate moieties until it comes into contact with colonic bacteria. Aminosalicylate would be helpful, but for symptoms of this severity, a corticosteroid will be necessary. . Unless the small bowel mucosal disease is very extensive, the macrocytic anemia is most likely caused by a deficiency of vitamin B12, which is absorbed in the terminal ileum.