A & 0x 3, CNII-XII intact, 5/5 upper and lower extremity strength bilaterally Labs Na 139 mEq/L Hgb 11 g/dL K2.9 mEg/L H
Posted: Mon Dec 20, 2021 9:07 am
A & 0x 3, CNII-XII intact, 5/5 upper and lower extremity strength
bilaterally
Labs
Na 139 mEq/L
Hgb 11 g/dL
K2.9 mEg/L
Hct 33%
C1 100 mEg/L
RBC 286 x
CO, 28 mEq/L
10%/m
BUN 18 mg/dL
PIt 400 x 10'/mm'
SCr 1.2 mg/dL
MCV 72 um'
Glu 104 mg/dL Phos 3.9 mg/dL
Ca 8.7 mg/dL
ESR 130 mm/h
WBC 19.7 × 10%/mm'
Neutros 67%
Bands 1%
Eos 2%
Lymphs 26%
Monos 4%
Stool O & P (-)
Stool C. Diff toxin (-)
AST 25 IU/L
ALT 28 IU/L
Alk phos 50 IU/L
Total bili 1.2 mg/dL
Direct bili 0.6 mg/dl
Albumin 3.8 g/L.
I Assessment
38 yo man presenting with new-onset Crohn's disease involving
the terminal ileum and ascending and transverse colon requiring
treatment
QUESTIONS
Problem Identification
1.a. Create a list of this patient's drug therapy problems.
1.b. What signs, symptoms, and laboratory alterations in this
patient are consistent with Crohn's disease?
1.c. How would you classify the severity of this patient's Crohn's
disease? Provide the rationale for your answer.
1.. What factors could lead to the development or exacerbation of
Cohn's disease in this patient?
1.e. What extraintestinal manifestations can develop in patients
with Crohn's disease?
Desired Outcome
2. Develop a list of pharmacotherapeutic goals for this patient.
Therapeutic Alternatives
3.a. What drug therapies could be used to treat this patient's
Cohn's disease?
3.b. When is surgical intervention indicated in patients with Crohn's
disease?
Optimal Plan
4. Develop a complete treatment plan for managing this patient's
Crohn's disease.
Outcome Evaluation
5. What parameters should be monitored to assess both the efficacy
and toxicity of your selected drug regimen?
Patient Education
6. How will you educate the patient about his Crohn's disease
therapy in order to enhance compliance, minimize adverse
effects, and promote successful therapeutic outcomes?
- CLINICAL COURSE
Mr. Jensen returns to his gastroenterologist for one of many follow-
up visits. It is now 18 months after treatment was started. He
achieved remission after 3 months of initial treatment and had only
a few intermittent episodes of diarrhea and abdominal pain for the
next 13 months. However, these episodes have become much more
frequent over the last 2 months and appear to be increasing in
severity. He has also developed two areas of skin breakdown on his
right lower abdomen that are continually draining a cloudy, foul-
smelling fluid. Upon further examination, these areas are deter-
mined to be enterocutaneous fistulae.
- FOLLOW-UP QUESTIONS
1. Given this new information, how would you modify the patient's
drug therapy?
2.
Should this patient undergo baseline testing to prevent or detect
bone loss?
- SELF-STUDY ASSIGNMENTS
1. Search for websites containing information about local support
groups in your area to which you may refer patients with Crohn's
disease for help and support.
2. Construct a table outlining the major differences between
Cohn's disease and ulcerative colitis.
3. Review the FDA pregnancy categories for the major drug classes
used for treatment of both active Cohn's disease and mainte.
nance of remission.
99
CHAPTER 32
Cohn's Disease
CLINICAL PEARL
Hospitalized patients with active Crohn's disease are at high risk for
blood clots due to their inflammatory state and should be placed on
prophylactic therapy for deep vein thrombosis.
REFERENCES
1. Hanauer SB, Sandborn W. Practice Parameters Committee of the
American College of Gastroenterology. Management of Crohn's dis-
ease in adults. Am ] Gastroenterol 2001;96:635-643.
2. Podolsky DK. Inflammatory bowel disease. N Engl J Med 2002;
347:417-429.
3. Kethu SR. Extraintestinal manifestations of inflammatory bowel dis-
cases. I Clin Gastroenterol 2006:40:467-475.
4. Buning C, Lochs H. Conventional therapy for Crohn's disease. World
I Gastroentero!2006:12:4794-4806.
5. American Gastroenterological Association Institute technical review
on corticosteroids, immunomodulators, and infliximab in inflamma-
try bowel disease. Gastroenterology 2006;130:940-987.
6. Guslandi M. Antibiotics for inflammatory bowel disease: do they
work? Eur I Gastroenterol Hepatol 2005;17:145-147.
7. Hancock L, Windsor AC, Mortensen NJ. Inflammatory bowel disease:
The view of the surgeon. Colorectal Dis 2006;8(Suppl 1):0-14.
8. Bressler B, Sands BE. Review article: medical therapy for fistulizing
Cohn's' disease. Aliment Pharmacol Ther 2006:24:1283-1293.
9. Bernstein CN, Leslie WD, Leboff MS. AGA technical review on osteopo-
rosis in gastrointestinal disease. Gastroenterology 2003;124:795-841.
bilaterally
Labs
Na 139 mEq/L
Hgb 11 g/dL
K2.9 mEg/L
Hct 33%
C1 100 mEg/L
RBC 286 x
CO, 28 mEq/L
10%/m
BUN 18 mg/dL
PIt 400 x 10'/mm'
SCr 1.2 mg/dL
MCV 72 um'
Glu 104 mg/dL Phos 3.9 mg/dL
Ca 8.7 mg/dL
ESR 130 mm/h
WBC 19.7 × 10%/mm'
Neutros 67%
Bands 1%
Eos 2%
Lymphs 26%
Monos 4%
Stool O & P (-)
Stool C. Diff toxin (-)
AST 25 IU/L
ALT 28 IU/L
Alk phos 50 IU/L
Total bili 1.2 mg/dL
Direct bili 0.6 mg/dl
Albumin 3.8 g/L.
I Assessment
38 yo man presenting with new-onset Crohn's disease involving
the terminal ileum and ascending and transverse colon requiring
treatment
QUESTIONS
Problem Identification
1.a. Create a list of this patient's drug therapy problems.
1.b. What signs, symptoms, and laboratory alterations in this
patient are consistent with Crohn's disease?
1.c. How would you classify the severity of this patient's Crohn's
disease? Provide the rationale for your answer.
1.. What factors could lead to the development or exacerbation of
Cohn's disease in this patient?
1.e. What extraintestinal manifestations can develop in patients
with Crohn's disease?
Desired Outcome
2. Develop a list of pharmacotherapeutic goals for this patient.
Therapeutic Alternatives
3.a. What drug therapies could be used to treat this patient's
Cohn's disease?
3.b. When is surgical intervention indicated in patients with Crohn's
disease?
Optimal Plan
4. Develop a complete treatment plan for managing this patient's
Crohn's disease.
Outcome Evaluation
5. What parameters should be monitored to assess both the efficacy
and toxicity of your selected drug regimen?
Patient Education
6. How will you educate the patient about his Crohn's disease
therapy in order to enhance compliance, minimize adverse
effects, and promote successful therapeutic outcomes?
- CLINICAL COURSE
Mr. Jensen returns to his gastroenterologist for one of many follow-
up visits. It is now 18 months after treatment was started. He
achieved remission after 3 months of initial treatment and had only
a few intermittent episodes of diarrhea and abdominal pain for the
next 13 months. However, these episodes have become much more
frequent over the last 2 months and appear to be increasing in
severity. He has also developed two areas of skin breakdown on his
right lower abdomen that are continually draining a cloudy, foul-
smelling fluid. Upon further examination, these areas are deter-
mined to be enterocutaneous fistulae.
- FOLLOW-UP QUESTIONS
1. Given this new information, how would you modify the patient's
drug therapy?
2.
Should this patient undergo baseline testing to prevent or detect
bone loss?
- SELF-STUDY ASSIGNMENTS
1. Search for websites containing information about local support
groups in your area to which you may refer patients with Crohn's
disease for help and support.
2. Construct a table outlining the major differences between
Cohn's disease and ulcerative colitis.
3. Review the FDA pregnancy categories for the major drug classes
used for treatment of both active Cohn's disease and mainte.
nance of remission.
99
CHAPTER 32
Cohn's Disease
CLINICAL PEARL
Hospitalized patients with active Crohn's disease are at high risk for
blood clots due to their inflammatory state and should be placed on
prophylactic therapy for deep vein thrombosis.
REFERENCES
1. Hanauer SB, Sandborn W. Practice Parameters Committee of the
American College of Gastroenterology. Management of Crohn's dis-
ease in adults. Am ] Gastroenterol 2001;96:635-643.
2. Podolsky DK. Inflammatory bowel disease. N Engl J Med 2002;
347:417-429.
3. Kethu SR. Extraintestinal manifestations of inflammatory bowel dis-
cases. I Clin Gastroenterol 2006:40:467-475.
4. Buning C, Lochs H. Conventional therapy for Crohn's disease. World
I Gastroentero!2006:12:4794-4806.
5. American Gastroenterological Association Institute technical review
on corticosteroids, immunomodulators, and infliximab in inflamma-
try bowel disease. Gastroenterology 2006;130:940-987.
6. Guslandi M. Antibiotics for inflammatory bowel disease: do they
work? Eur I Gastroenterol Hepatol 2005;17:145-147.
7. Hancock L, Windsor AC, Mortensen NJ. Inflammatory bowel disease:
The view of the surgeon. Colorectal Dis 2006;8(Suppl 1):0-14.
8. Bressler B, Sands BE. Review article: medical therapy for fistulizing
Cohn's' disease. Aliment Pharmacol Ther 2006:24:1283-1293.
9. Bernstein CN, Leslie WD, Leboff MS. AGA technical review on osteopo-
rosis in gastrointestinal disease. Gastroenterology 2003;124:795-841.