A 42-year-old man with long-standing Crohn disease presents to the emergency department with a 1-day

A 42-year-old man with long-standing Crohn disease presents
to the emergency department with a 1-day history of increasing abdominal
distension, pain, and obstipation. He is nauseated and has vomited bilious
material. He has no history of abdominal surgery and has had two exacerbations
of his disease this year. He is febrile with a temperature of 38.5°C.
Examination reveals multiple oral aphthous ulcers, hyperactive bowel sounds,
and a grossly distended, diffusely tender abdomen without an appreciable mass.
Abdominal radiographs reveal multiple air–fluid levels in the small bowel with
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A 42-year-old man with long-standing Crohn disease presents
to the emergency department with a 1-day history of increasing abdominal
distension, pain, and obstipation. He is nauseated and has vomited bilious
material. He has no history of abdominal surgery and has had two exacerbations
of his disease this year. He is febrile with a temperature of 38.5°C.
Examination reveals multiple oral aphthous ulcers, hyperactive bowel sounds,
and a grossly distended, diffusely tender abdomen without an appreciable mass.
Abdominal radiographs reveal multiple air–fluid levels in the small bowel with
minimal colonic gas, findings consistent with a small bowel obstruction.

Questions

A. Describe the significance of the oral aphthous ulcers in
the distribution of Crohn disease.

B. What factors are thought to be involved in the
pathogenesis of Crohn disease? What is the evidence to support the role of
cytokines in the pathogenesis of Crohn disease?

C. What are the GI complications of Crohn disease?

D. Describe some of the extraintestinal manifestations of
Crohn disease.

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