A 20-year-old female patient presents to your office with moderate upper abdominal pain, fatigue, recent 15 lb weight loss, and mouth sores that have intermittently reappeared for the last few months. She does not have much of a past medical history, outside of being a former smoker and lactose intolerance. She has a family history significant for undisclosed cardiac issues, glaucoma, lung cancer, Alzheimer’s, and Crohn Disease (McCance & Huether, 2019).
Physical assessment unremarkable outside of a tender abdomen to palpation and faint bowel sounds.
Vital Signs: BP 106/66
HR 82
Temp 99.9 F
RR 16
O2 98%
She has not had any lab work done in the last few years, so you decide to order a comprehensive metabolic panel (CMP) and complete blood count (CBC) for baseline testing. The CMP showed a low total protein and albumin level, and the CBC showed a low hemoglobin and hematocrit level. The patient has not noticed any signs of active bleeding, outside of her normal menstrual cycle, which has been nothing out of the norm per the patient (American Association of Clinical Chemistry [AACC], 2019).
Knowing that the gastrointestinal (GI) tract is a common area for one to lose blood, you order an occult stool test and an abdominal cat scan (CT). Baseline renal labs were drawn to assess that the baseline renal function was within normal limits in case contrast was to be used in the CT. Baseline renal function was within normal limits (AACC, 2019).
The occult stool was positive for occult blood and the CT showed fistulas in the terminal ileum and ascending colon, and strictures in the transverse colon. Based off of these results and the family history of Crohn Disease, you feel it necessary for the patient to be scheduled for a colonoscopy with a likely biopsy to rule out Crohn’s. You knew that Ulcerative Colitis was unlikely due to the CT findings in the terminal ileum. You also ordered more labs for further indication of Inflammatory Bowel Disease (IBD). These include labs for inflammatory markers, and an anemia panel (AACC, 2019).
The inflammatory markers were elevated, and the anemia panel showed a B12 deficiency, both of which are common in Crohn Disease. The B12 deficiency was a likely associated factor in the anemic finding from the original CBC. The colonoscopy showed signs of inflammation throughout the colon, but especially in the ascending and transverse colon, and the terminal ileum. Biopsies were taken from all three sites. The strictures found on the CT were also confirmed in the transverse colon (AACC, 2019).
The biopsies confirmed the diagnosis of Crohn Disease. You now realize that the mouth sores from the patient’s original office visit were also likely related to Crohn’s because you know this disease can affect anywhere in the GI tract from mouth to anus. The findings in the ascending and transverse colon also made sense because you know they are a common area of diseased bowel in Crohn’s (McCance & Huether, 2019).
With the new diagnosis came many questions from the patient. She first asked if her lactose intolerance had anything to do with the diagnosis. You tell her that it is unlikely, but that her family history, and history of smoking likely contributed. Her other risk factors included being a woman less than 40 years of age (McCance & Huether, 2019).
The patient was ordered prednisone and was scheduled for resection of the damaged areas of her GI tract, and had a long portion removed from her ileum and colon. Following surgery, you tell her that she is at a higher risk of Short Bowel Syndrome due to having less area for nutrients to be absorbed, which can cause nutritional deficiencies and diarrhea. The patient had an uncomplicated recovery from surgery and is now doing well being managed both with her diet and medically with yearly checkups (McCance & Huether, 2019).