MEDizzy - A 29-year-old woman presents with colicky lower abdominal

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Gastrointestinal System

A 29-year-old woman presents with colicky lower abdominal pain and frequent bloody diarrhea with mucus. Physical examination finds fever and peripheral leukocytosis, while multiple stool examinations fail to reveal any ova or parasites. A colonoscopy reveals the rectum and sigmoid portions of her colon to have superficial mucosal ulcers with hemorrhage, but regions more proximal are within normal limits. Which of the following histologic changes is most likely to be seen in a biopsy specimen taken from her rectum?

ExplanationThe term inflammatory bowel disease (IBD) is used to describe two idiopathic disorders that have many similar features, Crohn disease and ulcerative colitis. Histologically, both of these diseases produce distorted crypt architecture with crypt destruction and loss. These abnormalities of the colonic crypts help to differentiate IBD from infectious colitis. Both Crohn disease and ulcerative colitis produce acute and chronic inflammation of the colonic mucosa. Lymphocytes and plasma cells are increased in number in the lamina propria. Neutrophils may be seen within the colonic epithelium and, if present within the lumens of the crypts, may produce crypt abscesses. This latter change, however, is more commonly associated with ulcerative colitis. One important way to differentiate between these two inflammatory bowel diseases is the location of involved colon. Crohn disease may affect any portion of the GI tract, but most commonly there is involvement of the terminal ileum (regional enteritis) or the proximal portion (right side) of the colon. GI involvement is segmental with skip areas. In contrast, almost all cases of ulcerative colitis involve the rectum, and involvement extends proximally (left side) without skip lesions (diffuse involvement). This involvement causes the mucosa to bleed and forms large areas of mucosal ulceration