Inflammatory Bowel Disease Case Study 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?

Inflammatory Bowel Disease (IBD) is a chronic condition characterized by inflammation of the gastrointestinal tract. It includes two main types: Ulcerative Colitis (UC) and Crohn’s Disease (CD). This case study focuses on a young girl presenting with symptoms consistent with CD.

1. This patient was placed on immunosuppressive therapy because CD is an immune-mediated condition. The immune system mistakenly attacks the cells of the digestive tract, causing inflammation and damage. Immunosuppressive medications help to reduce the activity of the immune system, thereby reducing inflammation and symptoms. In this case, the aggressive immunosuppressive regimen was likely prescribed to control the inflammation and improve the patient’s condition.

2. The Meckel scan was ordered for this patient to rule out the presence of a Meckel diverticulum. Meckel diverticulum is a congenital abnormality of the small intestine that can sometimes cause symptoms similar to those of CD, such as abdominal pain and intestinal obstruction. It is important to rule out Meckel diverticulum as a cause of the patient’s symptoms before considering CD as the diagnosis.

3. Ulcerative Colitis (UC) and Crohn’s Disease (CD) are both types of IBD, but they have distinct clinical differences and treatment options. UC primarily affects the colon and rectum, causing continuous inflammation and ulcers in these areas. CD, on the other hand, can affect any part of the digestive tract, from the mouth to the anus, and can involve discontinuous areas of inflammation with skip lesions. Treatment for UC often involves medications that target the inflammation in the colon, such as aminosalicylates, corticosteroids, and immunosuppressants. In severe cases, surgery may be required to remove the affected colon. CD treatment options also include medications to reduce inflammation, but surgery is more commonly required due to the potential for strictures, fistulas, and abscesses. Additionally, CD patients may benefit from more specific medications, such as anti-TNF agents, which can target the underlying immune response.

4. The prognosis for patients with IBD can vary depending on various factors such as disease severity, location, and response to treatment. While IBD is a chronic condition that requires lifelong management, many patients can achieve remission and lead normal lives with proper medical care. However, it is important to note that both UC and CD have a relapsing-remitting course, meaning that periods of disease activity (flare-ups) can occur intermittently. Regular follow-up with healthcare providers is essential to monitor disease activity, adjust medications if needed, and detect any complications. Follow-up recommendations for managing IBD may include routine blood tests, imaging studies, endoscopy, and symptom monitoring. Additionally, patients may benefit from dietary and lifestyle modifications, as well as support from healthcare professionals and patient support groups.

In conclusion, this case study highlights the diagnosis and management of a young girl with Crohn’s Disease. Immunosuppressive therapy was used to control inflammation, and follow-up evaluations showed improvement in gastrointestinal function and resolution of anemia. The Meckel scan was ordered to rule out other potential causes of her symptoms. Understanding the clinical differences and treatment options for UC and CD is crucial in managing these chronic conditions. Regular follow-up and proactive management are essential for optimizing outcomes and the long-term prognosis of patients with IBD.