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Gastroenterology


Answer 5
  1. Crohn’s disease. This patient’s history and physical examination are most consistent with Crohn’s disease. Crohn’s disease is an inflammatory condition that can occur anywhere in the gastrointestinal tract but most commonly affects the small bowel. This patient’s right lower quadrant abdominal pains are suggestive of involvement of the terminal ileum, an area frequently affected. Involved intestine can become strictured (causing bloating secondary to partial obstruction), develop abscesses, or form fistulas (eg, enterocutaneous, enterovaginal, enteroenteric), which are often associated with fevers as well. Her ocular symptoms likely represent iritis, which is considered an extraintestinal manifestation of Crohn’s disease. Chronic appendicitis would be unlikely to be associated with iritis but could cause many of this patient’s symptoms. SLE could cause mesenteric vasculitis, which could mimic Crohn’s disease but would likely present with more diffuse abdominal pain as opposed to focal right lower quadrant pain. IBS is unlikely given her alarm symptoms (ie, fever, weight loss).

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