Mr. Brown, a 72 year old farmer, lives alone on a fixed income. He went to this physician complaining of being tired all of the time. His diet consists primarily of tea and toast. Blood work reveals his hemoglobin is 90, his hematocrit is .97 and he has a white blood cell count of 9 with a normal differential. His platelets are 300. No other manifestations are noted.

Normal values;

hemoglobin-140-180 g/L

hematocrit-400-540 L/L

leukocytes-4-11 X 10 E^9/L

platelets-150-400 X 10 E^9/L

Question: Which of the above blood studies would support his diagnosis?

A. Osteophytes and degenerated cartilage: In osteoarthritis, the articular cartilage progressively degenerates, and bone spurs (osteophytes) develop at joint margins. These structural changes create mechanical obstruction and pain, directly limiting joint movement and decreasing range of motion.

B. Wider joint space: Osteoarthritis is characterized by narrowing, not widening, of the joint space due to cartilage loss. A wider joint space would not contribute to decreased mobility and is not a feature of this condition.

C. Inflammation of compact bone: Osteoarthritis primarily affects the articular cartilage and subchondral bone rather than causing inflammation of compact bone. While subchondral changes can occur, inflammation of compact bone is not the main factor reducing range of motion.

D. Decrease in synovial fluid: Synovial fluid may become less effective due to cartilage damage, but its volume usually does not decrease significantly in osteoarthritis. Limited joint movement is more related to cartilage degeneration and osteophyte formation rather than fluid reduction.

E. Fibrosis of joint capsule: Joint capsule fibrosis can occur in late-stage osteoarthritis, contributing to stiffness, but the initial and primary cause of decreased range of motion is cartilage loss and osteophyte formation. Fibrosis is a secondary change rather than the primary mechanism.

A. Increased risk of colon cancer: Chronic inflammation of the colon in ulcerative colitis predisposes clients to dysplasia and an elevated risk of colorectal cancer. The risk increases with disease duration and extent, making regular surveillance essential.

B. Malabsorption in small intestine: Ulcerative colitis primarily affects the colon and rectum. Malabsorption is more characteristic of Crohn’s disease, which can involve the small intestine and impair nutrient absorption.

C. Development of fistulas: Fistula formation is common in Crohn’s disease due to transmural inflammation, whereas ulcerative colitis involves only the mucosa and submucosa, making fistulas rare.

D. Skip lesions: Skip lesions, or patchy areas of inflammation separated by normal tissue, are typical of Crohn’s disease. Ulcerative colitis usually presents with continuous inflammation starting from the rectum, not skip lesions.