ROSH Gastrointestinal Practice Exam

What is the most likely diagnosis for a patient with nonbloody diarrhea, abdominal pain, and small and large bowel findings of fissuring and cobblestoning?

1. Celiac disease

2. Crohn's disease

3. Lactose intolerance

4. Ulcerative colitis

The correct answer is: Crohn's disease

The symptoms described—nonbloody diarrhea, abdominal pain, and the specific bowel findings of fissuring and cobblestoning—are highly indicative of Crohn's disease. This condition is characterized by inflammation that can affect any part of the gastrointestinal tract and is particularly known for causing transmural inflammation, which leads to complications such as fissures and the cobblestone appearance observed on imaging or endoscopy. The presence of fissuring refers to the formation of cracks or ulcers in the bowel wall that can lead to complications and pain. Cobblestoning is a classic finding in Crohn's disease, representing the irregular appearance of the affected mucosa due to inflammation interspersed with intact mucosa. This is distinct from other gastrointestinal disorders. For example, celiac disease typically presents with symptoms related to malabsorption, including weight loss and changes in stool characteristics, but does not typically cause the specific findings of fissuring and cobblestoning. Lactose intolerance would not account for the findings seen in the bowel and is more characterized by gastrointestinal symptoms following lactose ingestion rather than chronic inflammation. Ulcerative colitis primarily affects the colon, usually leading to bloody diarrhea and pseudopolyps rather than the fissuring and cobblestoning seen in Cro