A 30-year-old man presents to the ED after a witnessed syncopal episode. He has been having bloody diarrhea and intermittent crampy abdominal pain for the past 3 months. A week later he has a colonoscopy and is found to have ulcerative colitis based on colonoscopy findings and mucosal biopsies. Which feature of listed below is NOT seen in ulcerative colitis?a. The terminal ileum shows inflammatory changes
Ulcerative colitis is a mucosal process in which the colonic mucosa and submucosa are infiltrated with inflammatory cells. The mucosa may be atrophic, and crypt abscesses are common. In long-standing ulcerative colitis, the colon may be foreshortened and the mucosa replaced by scar. Ulcerative colitis does not involve the small intestine, but the terminal ileum may demonstrate inflammatory changes ("backwash ileitis"). A key feature of ulcerative colitis is the continuous involvement of the rectum and colon; rectal sparing or skip lesions suggest a diagnosis of Crohn disease.