Which of the following associated disorders may a client with ulcerative colitis exhibit?
A. Gallstones
B. Hydronephrosis
C. Nephrolithiasis
D. Toxic megacolon
Correct Answer: D. Toxic megacolon
Toxic megacolon is extreme dilation of a segment of the diseased colon caused by paralysis of the colon, resulting in complete obstruction. This disorder is associated with both Crohn’s disease and ulcerative colitis. When the muscularis propria is involved it may lead to damage to the nerves resulting in dilatation, aperistalsis, and ischemia (toxic megacolon). Today, toxic megacolon is the most common cause of death in ulcerative colitis. At least 5% of patients develop colon cancer and this risk increases with the duration of the disease. The other disorders are more commonly associated with Crohn’s disease.
Option A: The prevalence of gallstone disease in patients with Crohn’s disease is about two-fold higher than that in the general population. One hypothesis for the increased prevalence of gallstone disease in patients with Crohn’s disease is that the bile acid malabsorption in patients with diseased or resected ileum may lead to cholesterol supersaturated bile.
Option B: Ureteric stenosis with resulting hydronephrosis has been described as a serious complication of inflammatory bowel diseases, especially of Crohn’s disease (CD), necessitating urological intervention. This complication predominantly affects the right renal system in CD and seems to be a mechanical obstruction caused by inflammatory penetration from the affected distal ileum into the retroperitoneum, irrespective of urolithiasis.
Option C: In about 30% of the patients with Crohn’s disease can be found extra-intestinals symptoms. Nephrolithiasis is one of them and the appearance of kidney stones, mainly of oxalate of calcium, is more common in these patients than in the general population.
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