Answer Happy

98 32 Father with DM, mother with HTX. Older siete with God's SECTION 4 Gastrointestinal Disorders CROHN'S DISEASE Married with two children ages and Works sales represen A Sense of Urgency Level lative for pharmaceutical company. Occasional kebole on the dende Smokes 10 years Brian A. Hemstreet, PharmD, EPS Meds Lamera 15 mg po PRN Cetine 10mg ponce daily LEARNING OBJECTIVES Fuschl once daily Mobilepom po PRN After completing this case study, students should be able to Ketoprofen 12.5 mg po Q4.6 PN pain • Describe the typical clinical presentation of active Cohn's de Abel MPRNeto de case, induding signs, symptoms, and disease in and severity Cabinet ) . Sentity exacerbating factors and potential complications of Salla drug (ovete rush) Crohn's disele • Recommend appropriate pharmacologe treatment for active Crohn's disease Reports font colper day with intermittent Head campy dominal pain and occa Fedeweryfgoed • Awww mnie towcities of drugs commonly used for managing way. So recent weight lot sick contacts Honbury three Crohn's disease to four times a week and those two times a week. No • Ecatepetent on the proper use of medications used to cost SOK HA. « mental status changes. No knee or paint pain treat he's disease Sedie eerste om Physical Examination PATIENT PRESENTATION Ger Chief Complaint Will developed Caucasian make itn mid distres T'm having a lot of diarrher and I feel really rendere 15 Sining BP108.92: Standing HPIM2A,19%, RR 17.TWG WERS John is a 38-year-old man with a month history of intermittent plade of watery diarth scrapy pain. He state that recently hin puolesheve increased in the Palio dry flakydin, noloo embo quency, and he is now having five to lose we day. We reports intermine fever, as well as male and fatigue MEENT Over the last 2 weeks, he has also noticed Wed in me of his PERLA, BOM, pel conjunctivae, dry mucous membranes, intact Mools Theeymtoms he condignificant problem with his deteropharynx deat job, as bei reprentative for a pharmaceutical.com pends a lot of time driving. He has tried OTC letopolen for the Niechodes abdominal pain and Peplo Blamed for the diarthen both with Trachea midine. (-) shytomegaly. (- lymphadenopathy. CD have provided interiel Hechthin daycare we not been in the last few month. He does not really ang Thor exposure to other sick contact. Het recent international станиетану travel. His PCP hered him to a gastroenterologista colocopy revealed a patchy cobblestone pulem of lammation in the C terminalileum and the scending and tree color. The inflam Tachycardic, soulat shythm, no MRG matory process stendi below the intestinal, and there is evidence of mucosal friable and recent being a fogyote Add intestinal mucos revealed leukocyte infomacal Dhithun upper and lowes quadrant tendomen, distended: +) granuloma consistent with active Credene AS ->HSM PM Cented GERD Pratesine WNE. (-tendemes Sinusitis last treated with antibiotic this) Home Seasonal allergic rhinitis Exercise-induced bronchoconstriction MSER AC. pair of the right knee year Ne CVA senderen
99 CHAPTER 32 Crohn's Disease New CLINICAL COURSE AXOXS.CN I-XII intact. S/S upper and lower extremity strength Mr. Jensen returns to his gastroenterologist for one of many follow bilaterally up visits. It is now 18 months after treatment was started. He Labs achieved remission after 3 months of initial treatment and had only a few intermittent episodes of diarrhea and abdominal pain for the x 15 months. However, there is have become much more Nem ALT 100 CM Bundes A phet frequenter the last 2 months and appear to be increasing in COEL To severity. He has also developed two of skin breakdown on his mit right lower abdomen that are continually draining a douly, foul- 12 M12 M smelling fluid. Upon further examination, these areas are deter GOPA mined to be enterocutaneous fistulae. GESC Assessment FOLLOW-UP QUESTIONS 38 yo man presenting with new-onset Crohn's disease imoving 1. Given this new information, how would you modify the patient's the terminal ileum and ascending and transverse colon requiring drug therapy treatment 2. Should this patient undergo baseline testing to prevent or detest bene? QUESTIONS SELF-STUDY ASSIGNMENTS 1. Search for websites containing information about local support Problem Identification groups in your area to which you may refer patients with Crohn's 1. Create a list of this patient's drag therapy problems disease for help and support 1.b. What signs, symptoms and laboratory alterations in this 2. Construct a table outlining the major differences between patient are consistent with Crohn's disease Crohodie in cerative coliti 1. How would you classify the severity of this patient's Crohn's 3. Review the FDA pregnancy categories for the major drug des disease? Provide the rationale for your answer used for treatment of both active Crohn's disease and mainte- 1.d. What factors could lead to the development of exacerbation of hance of remia Crohn's disease in this patient? Te What extraintestinal manifestations can develop in patients CLINICAL PEARL with Crohn's dias Hospitalized patients with active Crohn's disease are at high risk for Desired Outcome blood dos doc to their inflammatory state and should be placed on prophylactic therapy for de veinthe 2. Deschipa list of pharmacotherapeutic prals for this patient Therapeutic Alternatives REFERENCES 3.2. What drug therapies could be used to treat this patient's Crohn's disease 1. HSR Sunborn W. Practice Purmela Commor the American College of Gastroenterology Manager of Cho's dis- 35. When is surpcal intervention indicated in patients with Crohn's contin adults. Am I Getro 2005-613 2. Podelky D. Inlay bowd die Ning Med 2000 30:417-420 Optimal Plan 3. Kathu SR. Extraintestinal manifestations of ammatory bowel dis- Clin Gastroenterol 2016-17 t. Develop a complete treatment plan for managing this patients 4. HC.techs H. Commonly for disse World Crohn's disease Gastroenterol 12.06 5. American Gastroenterological Association inste technical review Outcome Evaluation ni immunomodulates and infimab in me tory bowel discuse Gastrology 2006 1305-987. 5. What parameters should be monitored to assess both the efficacy Goslanci M. Antibiotics for inflammatory bodiese do they and toxicity of your selected drugiment work! Tur 1 Gastroenterol Hepatol 2005:17:145-147 7. Hancock , WC Melatory bowe Patient Education The viewed the con Colorectal De 2006. Sappl 10-16 de Sands BE. Review artide medical therapy for fistulicing How will you educate the patient about hin Crohn's disease Codice. Ale Pharmacol Ther 200431383-1283 therapy in order to enhance compliance, minimize adverse 9. Besten N. WELMS. AGA technical effects and promote successful therapeutic outcomes Toisin testinal disease. Gastroenterology 2005:124795-640