College of Pharmacy
Case:
CC: Bloody diarrhea and abdominal pain
HPI: The patient, a 25-year-old white male, was well and in his usual state of excellent health until 3 months ago when he had 3 to 4 days of bloody diarrhea. The diarrhea recurred approximately 4 times in the past 2 months; typically, it would last for several days, then resolve. The diarrhea was described as loose to semi-solid bowel movements occurring 4 to 5 times per day, and usually associated with mild cramps and left lower quadrant abdominal pain. With each bowel movement, there was a small amount of bright red blood. The blood was seen on the toilet tissue and mixed with dark yellow to brown stool. The most recent episode was more severe and lasted longer than usual (more than 6 days). The patient denies fever, night sweats, nausea, vomiting, abdominal bloating or distension, fecal urgency, joint pain, and rash. He denies unusual food exposures or recent travel. There have been no ill contacts. He reports that he has lost about 10 pounds unintentionally over the last 3 months.
PMH: occasional tension headaches
Medications: ibuprofen 400 mg prn headaches
FH: mother has Crohn’s disease.
SH: pt smokes about 1ppd
PE: only abdominal tenderness on palpation/percussion
Labs: Hgb 12.5, HCT 36, the rest unremarkable, stool cultures are negative, stool analysis is negative for ova and parasites
Pts' physician has clinical suspicion that this patient has IBD.
Questions:
What additional tests will pt’s physician need to support this provisional diagnosis and to differentiate b/w Crohn’s Disease (CD) and Ulcerative Colitis (UC)?
What clinical and diagnostic features can help to differentiate b/w UC and CD?
What are the common complications of IBD?
What are the goals of therapy for IBD?
If this patient had UC, what are possible treatment options?
If this patient had CD, what are possible treatment options?
What else dose this patient need to know?