Crohn’s Disease Case Study
Crohn’s Disease Case Study
Case Overview
The case study is of a female patient 18-years of age with complaints of recurrent abdominal pain for two weeks. She also has a history of cramping, low-grade fever, loss of appetite, diarrhea, and Crohn’s disease. The patient admits to smoking in the last two years, half a packet per day but denies substance or alcohol use.
Differential Diagnosis
Chron’s Disease Flares. Flares are a recurrence of Crohn’s disease (CD) symptoms for individuals with a history of CD. It causes inflammation in the gastrointestinal (GI) tract resulting in nausea, abdominal cramps, diarrhea, rashes, rectal pain, and joint pain (Ko, Abraham & Shih, 2018). During an episode of flares, there is an increase in body temperature due to inflammatory mediators’ production. Possible causes of flares are NSAIDs, smoking, stress, and disruptions in medications (Panés & Rimola, 2017). The presence of CD flares is a probable diagnosis based on positive symptoms of cramping, diarrhea, low-grade fever, loss of appetite, as well as a history of CD and smoking.
Giardiasis: It is a diarrheal disease that presents with symptoms of diarrhea, flatulence, abdominal cramps, nausea, vomiting, low-grade fever, loss of appetite and weight loss (Tontini et al., 2015). In the present case, this is a possible diagnosis based on the positive symptoms of diarrhea, abdominal cramps, loss of appetite, and low-grade fever.
Amebic colitis: Amebic colitis develops gradually and with diarrhea as a typical symptom. Other clinical symptoms include abdominal cramping, rectal bleeding, loss of appetite, weight loss, and fever, which last for 1-2 weeks (Tontini et al., 2015). Amebic colitis is a probable diagnosis based on the patient’s history of diarrhea, abdominal pain for two weeks, low-grade fever, and loss of appetite.
Important Focused Physical Exam Findings
Abdominal masses: A discrete mass or abdominal fullness, especially in the right lower quadrant, indicates an involvement of the ileum (Panés & Rimola, 2017). A patient having an inflamed bowel may have a palpable mass which results from thickening of the colon.
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Abdominal tenderness: Diffuse localized pain on palpation is a clinical sign of GI inflammation (Ko, Abraham, & Shih, 2018). Tenderness in the left lower quadrant mostly results from inflammation in the sigmoid colon.
Rectal examination findings: Positive examination findings of rectal fistulae, ulcers, skin tags, abscesses, and scars are indicative of CD (Panés & Rimola, 2017). A digital rectal examination would be helpful to assess the sphincter tone and detecting abnormalities in the mucosa of the rectum.
Diagnostic Tests
In the present case, Barium contrast radiology will be useful in detecting and staging the inflammation process as well as identifying lesions in the small bowel that indicate a CD diagnosis (Ko, Abraham & Shih, 2018). Further, inflammatory markers test will also play a fundamental role. This test will include assessing the level of C-reactive protein (CRP) and Erythrocyte sedimentation rate (ESR). They will be useful in making a diagnosis and predicting the development of CD (Loddo & Romano, 2015). CD presents with elevated levels of CRP and ESR due to GI inflammation. Lastly, a stool culture test will also be conducted. Stool samples will be tested to identify if there are ova, parasites, occult blood, white blood cells, pathogens, and Clostridium difficile toxins.
Treatment Plan
Medications: Metronidazole 500 mg PO TDS for 5 days; it acts as a
Oral Prednisone 40mg/day for 7 days; to decrease inflammation.
Imodium 2 mg Qday for 2 days; to relieve diarrhea.
Delzicol 800 mg PO TDS; for long term maintenance and prevention of remissions.
Health Education: I will recommend the patient to quit smoking since it triggers CD flares and is a causative factor of major respiratory and chronic conditions (Loddo & Romano, 2015). Besides, I will advise the patient to avoid NSAIDs and spicy foods since they cause flares. I will further advise the patient to prevent stress by adopting coping mechanisms since stress causes remission of flares.
Follow-up: The patient will be scheduled for a monthly follow-up for evaluation of progress and re-evaluation of treatment.
Crohn’s Disease Case Study References
Ko, J. Z., Abraham, J. P., & Shih, D. Q. (2018). Pathogenesis of Crohn’s Disease-and Ulcerative Colitis-Related Strictures. In Interventional inflammatory bowel disease: endoscopic management and treatment of complications (pp. 35-41). Academic Press.
Loddo, I., & Romano, C. (2015). Inflammatory bowel disease: genetics, epigenetics, and pathogenesis. Frontiers in immunology, 6, 551.
Panés, J., & Rimola, J. (2017). Perianal fistulizing Crohn’s disease: pathogenesis, diagnosis, and therapy. Nature Reviews Gastroenterology & Hepatology, 14(11), 652.
Tontini, G. E., Vecchi, M., Pastorelli, L., Neurath, M. F., & Neumann, H. (2015). Differential diagnosis in inflammatory bowel disease colitis: state of the art and future perspectives. World journal of gastroenterology: WJG, 21(1), 21.
An 18 year old white female presents to your clinic today with a 2 week history of intermittent abdominal pain. She also is positive for periodic cramping and diarrhea as well as low grade fever. She also notes reduced appetite. She notes that She admits smoking ½ PPD for the last 2 years. Denies any illegal drug or alcohol use. Does note a positive history of Crohn’s Disease. Based on the information provided answer the following questions:
What are the top 3 differentials you would consider with the presumptive final diagnosis listed first?
What focused physical exam findings would be beneficial to know?
What diagnostic testing needs completed if any to confirm diagnosis?
Using evidence based treatment guidelines note a treatment plan.
