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Skip lesions
5%
7/144
Noncaseating granuloma
6%
8/144
Fistulas and strictures
Rectal involvement
79%
114/144
Cobblestone mucosa
3%
5/144
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This man has pseudopolyps and inflammation of the mucosa and submucosa only, which is characteristic of ulcerative colitis (UC). UC always starts at the rectum and progresses continuously. UC is an idiopathic auto-inflammatory disease of the colon. UC always starts in the rectum and spreads proximally. Lesions in UC are always contiguous, and skip lesions are not seen. Risk factors for UC include white race and Ashkenazi Jewish heritage. Gross findings in UC include friable mucosal patches and pseudopolyps. There may be a loss of haustra in the colon, which can give a "lead pipe" appearance on abdominal imaging. Toxic megacolon and colorectal carcinoma are feared complications of UC. Adams and Bornemann review the presentation of UC. UC typically presents with hematochezia, diarrhea, and pain in the abdomen. In contrast, Crohn's may or may not present with bloody bowel movements. The onset of symptoms in UC can be insidious or it can be abrupt. ESR and CRP are not sensitive markers for the diagnosis of UC, and many individuals have normal ESR and CRP at the time of diagnosis. Gramlich and Petras discuss the histological findings in UC. Distortion of the mucosal lining is the most common finding in UC. In UC, crypts are typically atrophic and do not extend to the muscularis mucosa as they ordinarily would. A lymphoplasmacytic infiltrate of the lamina propria may be seen. Inflammatory changes do not extend further than the submucosa, which is in contrast to the transmural inflammation that is seen in Crohn's disease. Illustration A shows pseudopolyps in the colon of a UC patient. Illustration B shows a crypt abscess, a classic histological findings associated with UC. Illustration C shows lymphocytic infiltration of the mucosa and distortion of crypt architecture. Illustration D compares the characteristic findings of Ulcerative Colitis with those of Crohn's Disease Incorrect Answers: Answers 1-3, 5: The remaining incorrect answers are findings associated with Crohn's disease, but not associated with UC.
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