Which of the following symptoms is associated with ulcerative colitis?
A. Dumping syndrome
B. Rectal bleeding
C. Soft stools
D. Fistulas
Correct Answer: B. Rectal bleeding
In ulcerative colitis, rectal bleeding is the predominant symptom. Ulcerative colitis is an idiopathic inflammatory condition of the colon which results in diffuse friability and superficial erosions on the colonic wall associated with bleeding. It is the most common form of inflammatory bowel disease worldwide.
Option A: Dumping syndrome occurs after gastric surgeries. Dumping syndrome is likely caused by the rapid movement of chyme. In patients without gastric surgery, digestion is initiated in the stomach, and the transition to the duodenum occurs progressively. The severity of dumping syndrome is correlated to the extent of gastric surgery. Surgical etiologies include gastrojejunostomy, antrectomy, pylorectomy, pyloroplasty, esophagectomy, vagotomy, Roux-en-Y bypass, and Nissen fundoplication.
Option C: Soft stools are more commonly associated with Crohn’s disease, in which malabsorption is more of a problem. Steatorrhea from malabsorption can occur with Crohn’s disease. The inflammatory process caused by Crohn’s disease, especially if it involves large tracts of intestine, alters the absorption mechanisms of different substances due to the lack of reabsorption of the bile salts, which normally stimulate the reabsorption of food fats.
Option D: Fistulas are associated with Crohn’s disease. Fistulas occur in all these areas, but the anorectal area is most common because of the relative thinness of the intestinal wall in this area. The initial lesion starts out as an infiltrate around an intestinal crypt. This goes on to develop ulceration first in the superficial mucosa and involves deeper layers. As the inflammation progresses, non-caseating granulomas form involving all layers of the intestinal wall.
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