28 Sep Inflammatory Bowel Disease

Case Study :

Inflammatory Bowel Disease 

The  patient is an 11-year-old girl who has been complaining of intermittent  right lower quadrant pain and diarrhea for the past year. She is small  for her age. Her physical examination indicates some mild right lower  quadrant tenderness and fullness.

Studies Results Hemoglobin  (Hgb), 8.6 g/dL (normal: >12 g/dL) Hematocrit (Hct), 28% (normal:  31%-43%) Vitamin B12 level, 68 pg/mL (normal: 100-700 pg/mL) Meckel  scan, No evidence of Meckel diverticulum D-Xylose absorption, 60 min: 8  mg/dL (normal: >15-20 mg/dL) 

120 min: 6 mg/dL (normal: >20 mg/dL) 

Lactose  tolerance, No change in glucose level (normal: >20 mg/dL rise in  glucose) Small bowel series, Constriction of multiple segments of the  small intestine 

Diagnostic Analysis 

The child’s small  bowel series is compatible with Crohn disease of the small intestine.  Intestinal absorption is diminished, as indicated by the abnormal  D-xylose and lactose tolerance tests. Absorption is so bad that she  cannot absorb vitamin B12. As a result, she has vitamin B12 deficiency  anemia. She was placed on an aggressive immunosuppressive regimen, and  her condition improved significantly. Unfortunately, 2 years later she  experienced unremitting obstructive symptoms and required surgery. One  year after surgery, her gastrointestinal function was normal, and her  anemia had resolved. Her growth status matched her age group. Her  absorption tests were normal, as were her B12 levels. Her  immunosuppressive drugs were discontinued, and she is doing well. 

Critical Thinking Questions 

1. Why was this patient placed on immunosuppressive therapy?

2. Why was the Meckel scan ordered for this patient? 

3. What are the clinical differences and treatment options for Ulcerative Colitis and Crohn’s Disease? (always on boards) 

4. What is prognosis for patients with IBD and what are the follow up recommendations for managing disease?