# A nurse is reviewing the colonoscopy report for a client presenting with chronic abdominal symptoms and suspected Crohn's disease. Which observation is most indicative of this diagnosis?

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## 문제

A nurse is reviewing the colonoscopy report for a client presenting with chronic abdominal symptoms and suspected Crohn's disease. Which observation is most indicative of this diagnosis?

## 보기

1. Continuous inflammation from rectum proximally with bloody diarrhea
2. Left lower quadrant pain with fever and segmental colitis
3. Right lower quadrant pain with skip lesions on colonoscopy **✔ 정답**
4. Rectal bleeding with superficial inflammation and tenesmus

**정답: 3**

## 해설

Crohn's disease characteristically presents with right lower quadrant pain due to terminal ileum involvement and skip lesions (discontinuous areas of inflammation) on colonoscopy, which are pathognomonic features. Option 1: Bloody diarrhea with mucus and tenesmus is more characteristic of ulcerative colitis. Option 2: Left lower quadrant abdominal pain with fever is typical of diverticulitis or ulcerative colitis, not Crohn's. Option 4: Rectal bleeding with superficial mucosal inflammation is common in ulcerative colitis or hemorrhoids, not deep-seated inflammation of Crohn's.

## 심화 해설

Correct Answer: 3

The hallmark endoscopic finding that most strongly indicates Crohn's disease (CD) rather than other forms of inflammatory bowel disease is the presence of skip lesions, which are areas of inflammation interspersed with normal-appearing mucosa. This discontinuous pattern is a defining characteristic of CD's pathology.

A key study by Solitano et al. (2025) reinforces this concept, describing CD as being "characterized by discontinuous inflammation" [1]. The research highlights the clinical significance of identifying these skip lesions, noting that a failure to recognize them can directly lead to incorrect management of the disease [1]. This discontinuous pattern is not just a visual finding on colonoscopy; it reflects the underlying transmural and segmental nature of the disease, which can also manifest as "endoscopic skipping," where the terminal ileum appears normal on colonoscopy but proximal small bowel inflammation is visible on cross-sectional imaging [1]. The right lower quadrant pain correlates with the frequent involvement of the terminal ileum in CD.

The other options describe findings more consistent with ulcerative colitis (UC) or other conditions. Continuous inflammation starting at the rectum and moving proximally is the classic presentation of UC, not the segmental pattern of CD. While segmental colitis can be seen in other contexts, the specific combination of right lower quadrant pain with endoscopically confirmed skip lesions is the most pathognomonic finding for CD among the choices provided. The study by Kökbaş et al. (2026) also supports the importance of endoscopic evaluation in diagnosing IBD, with its investigation into bowel wall thickness measured by ultrasonography as a correlate to the endoscopic and histopathological findings that define these conditions [2].References (research sources)

- [1]Endoscopic Skipping, Stricturing, and Penetrating Complications in Crohn's Disease on Tandem Ileo-colonoscopy and Cross-sectional Imaging: A Retrospective Cohort Study.Research articleSolitano V, Vuyyuru SK, Aruljothy A, Alkhattabi M, Zou J, Beaton M, Gregor J, Kassam Z, Sedano R, Marshall H, Ramsewak D, Sey M, Jairath V. (2025) · DOI: 10.1093/ibd/izae192

- [2]The Role of Intestinal Ultrasonography in Children with Inflammatory Bowel Disease.Research articleKökbaş İ, Hasbay E, Aksoy B, Çağan Appak Y, Çetinoğlu S, Kahveci S, Onbaşı Karabağ Ş, Güler S, Baran M. (2026) · DOI: 10.5152/tjg.2026.25401

## 임상 시나리오

Differentiating Crohn's Disease on EndoscopyKey findings to distinguish from Ulcerative Colitis
The hallmark of Crohn's disease is discontinuous inflammation, visualized as skip lesions with areas of normal mucosa between inflamed segments. This reflects the underlying transmural nature of the disease.

The most common location is the terminal ileum, causing right lower quadrant pain. In contrast, ulcerative colitis shows continuous, superficial inflammation starting at the rectum and moving proximally.

CautionFailure to recognize skip lesions can lead to incorrect disease classification and management. A normal-appearing terminal ileum on colonoscopy does not rule out proximal small bowel disease; cross-sectional imaging may be needed.

## 핵심 개념

- **Skip Lesions** — Discontinuous, patchy areas of inflammation interspersed with normal-appearing mucosa, a hallmark endoscopic feature of Crohn's disease.
- **Transmural Inflammation** — Inflammation affecting the entire thickness of the bowel wall, characteristic of Crohn's disease and leading to complications like fistulas.
- **Terminal Ileum** — The most common site of involvement in Crohn's disease, often presenting with right lower quadrant pain.
- **Ulcerative Colitis** — A form of IBD characterized by continuous, superficial inflammation that begins in the rectum and extends proximally.

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