1. Amyloidosis
2. Pyoderma gangrenosum
3. Primary sclerosing cholangitis
4. Arthropathy
Select the correct answer using the code given below.
Extraintestinal Manifestations of Crohn's Disease: Activity-Related vs Activity-Independent
Extraintestinal manifestations (EIMs) of Crohn's disease are classically divided into two groups: those that parallel bowel disease activity (they flare and remit along with the intestinal inflammation) and those that follow an independent course (persisting or appearing even when the bowel disease is quiescent, and not improving with control of gut inflammation). The correct answer is 1, 2 and 4 — Amyloidosis, Pyoderma gangrenosum, and Arthropathy.
Analysis of Each Option
- Amyloidosis (1) — Related to disease activity: Secondary (AA) amyloidosis is a consequence of sustained, poorly controlled chronic inflammation in Crohn's disease. Its risk and progression correlate with the cumulative burden of active inflammatory disease, and effective control of bowel inflammation reduces amyloid deposition — hence it is grouped with activity-related EIMs.
- Pyoderma gangrenosum (2) — Related to disease activity: Along with erythema nodosum, peripheral (type 1) arthropathy, and oral aphthous ulcers, pyoderma gangrenosum typically flares in tandem with active luminal disease and often improves as the underlying colitis/Crohn's disease is treated.
- Primary sclerosing cholangitis (3) — NOT related to disease activity: PSC is a classic example of an EIM that runs an independent course. It can develop, progress, or even first appear years after the colon has been removed or the bowel disease is in complete remission, and treating the bowel inflammation does not alter its progression. This is the key reason option 3 must be excluded.
- Arthropathy (4) — Related to disease activity: Peripheral arthropathy (type 1, large-joint, pauciarticular) closely mirrors bowel disease activity and improves when the intestinal inflammation is controlled. (Axial disease such as ankylosing spondylitis/sacroiliitis, by contrast, is activity-independent, but the question asks about arthropathy in general, which is dominated by the activity-related peripheral pattern.)
Conclusion
Since Amyloidosis, Pyoderma gangrenosum, and Arthropathy track with bowel disease activity, while Primary sclerosing cholangitis characteristically does not, the correct combination is 1, 2 and 4.
Important Questions from Intestines
- An eight month old male child is brought to the emergency with recurrent episodes of screaming and drawing up of legs. The child appears to be listless in between the attacks. Local examination of abdomen reveals feeling of emptiness in the right iliac fossa and blood stained mucus is found on the finger on per rectal examination. The most probable clinical diagnosis in this child is
Which of the following statements regarding Ogilvie's syndrome are correct?
1. It presents as acute large bowel mechanical obstruction
2. Marked caecal dilatation is a common feature on X-ray abdo- men
3. Caecal perforation is a well recog- nized complication of this condi- tion
4. Intravenous Neostigmine is used for the treatment of this condition
Select the correct answer using the code given below :
- Among the extra intestinal manifesta- tions of Crohn's disease which one of the following is related to the disease activity?
- A 35 year old male patient with enteric fever presents to the emergency with sudden onset of generalised abdominal pain, abdominal distension, nausea, vomiting and constipation for last 48 hours. On examination, patient is dehydrated with PR = $110/min$ and BP = $100/60$ mm Hg. There is genera- lised tenderness, rebound tenderness present and board like rigidity on per- abdomen examination. The most likely complication of enteric fever in this patient is
- Which of the following are the intraoperative features of viable small bowel?
1. Visible peristalsis
2. Flabby intestinal musculature
3. Shiny appearance of small bowel wall
4. Visible pulsation in the mesenteric artery
Select the correct answer using the code given below.
