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The patient is an 18-year-old of the Filipino-American origin. He has no known family history of ulcerative colitis or chronic illnesses similar to colitis. He is a high school senior student.
The patient complains of diarrhoea 3-4 times a month although it has been on and off for one year. There is no known allergy that the patient experiences.
He experienced rectal bleeding, rectal pain and often had an urgent need to empty his bowels. His diarrhoea had bloodstains with mucus at least once a month. This led to few red blood cells due to the low level of iron, which resulted from the bloody stool. He had belly pains, which he described as cramping and his belly felt sore if touched. He experienced constipation, but it was less frequent than diarrhoea. He had no signs of vomiting or nausea, but he had a loss of appetite. Sometimes he would develop signs of fever or other symptoms, which affected the whole body. Another symptom was loss of weight. The high school senior claimed that he recently lost some weight during the wrestling season States, but he attributes it to stress due to college entrance and grades.
The patient received medical attention for a similar episode a year ago. The paediatrician who examined him suggested that the patient receives a rectal tag surgical consult. He placed him on iron pills due to the patients low haemoglobin level. The preoperative diagnosis for the patient was rectal bleeding and diarrhoea. He received premedication that consisted of 5 mg of Versed IV and 75 mg of Demerol. The doctors performed a colonoscopy operation along with biopsy. There were no blood tests from the previous medical records.
Findings on assessment
When the patient visited the hospital, the doctor took his blood sample for testing. The blood test drawn during his visit CBC: WBC-7.82 RBC-4.91 HGB-11.7 (L) HCT-36.8 (L) MCV-74.9 (L) MCH-23.8 (L) MCHC-31.8 (L) PLT-474 (H) MPV-9.1 (L) CMP-NORMAL TSH-1.344 (NORMAL) was then sent to a gastroenterologist who carried out a colonoscopy. The results showed that the patient had a case of severe ulcerative colitis, which had affected three fourth of his colon. The ulcerative colitis extended to the hepatic flexure region from the rectum. The disease had not affected the terminal ileum, ascending colon and the cecum. The patient also had some internal haemorrhoids. The remaining analysis was ordinary.
Results of pertinent diagnostic tests
The test entailed the removal of tissue (colon) to study it for disease. The pathologists received three specimens the colon, random and the biopsy. The test showed colonic mucosa with a distinctive active colitis. There was no presence of dysplasia, but there was a distortion of the colonic mucosa structure. There was also formation of cryptitis, crypt abscess and mucosal formation. The pathologist recommended clinical correlation by way of colonoscopic findings in order to rule out the infectious etiology against the disease of the inflammatory bowel.
The procedure involved placing him in a left lateral decubitus position. The result of the examination of the digital rectal and external rectal was normal. The placing of the pediatric colonoscope into the cecum from the rectum then followed. The transillumination, ileocecal valve and appendiceal orifice characterises the cecum. The doctor intubated the ileum, then withdrew the colonoscope, and slowly took it out. The patient then underwent random colon biopsies. There was no report of any immediate complications.
In this case, the doctor recommended that, the patient start on opius along with prednisone. There was then a follow-up on the results of the biopsy and the doctor advised the patient to eat a low-fibre diet. The patient should visit the doctor in the office at least 3-4 times in a week.
Discuss the differential diagnoses (at least 5) and how final one selected and others eliminated
This is an inflammatory bowel disease, which causes swelling of the digestive tract lining. This can result to severe diarrhoea, malnutrition and abdominal pains. Inflammation that results from the Crohn's disease may entail various digestive tract areas in different people. This inflammation frequently spreads deeply to the affected bowel areas. The disease can be both debilitating and painful with some cases of life-threatening complications. Therapies are essential for reducing the symptoms and signs of Crohns disease and bringing a lasting remission since there is no known cure. Many individuals who have this disease are able to function properly with treatment (Baumgart, 2012).
This is a severe inflammation of the colon, which is the digestive system part that stores waste material. The commonest symptoms of ulcerative colitis are bloody diarrhoea and abdominal pain. Patients may also experience fatigue, loss of appetite, joint pain, anaemia, loss of weight, and skin lesions. Others include rectal bleeding, growth failure, loss of nutrients and body fluids. Approximately, half of patients with ulcerative colitis experience mild symptoms with others suffer bloody diarrhoea, nausea, abdominal cramps and frequent fevers. Ulcerative colitis may result to other problems such as eye inflammation, osteoporosis, liver disease and arthritis. There is no known reason as to why these problems take place outside the colon (Bayless & Hanauer, 2010).
Irritable bowel syndrome
This is a common disorder, which affects an individual's large intestines. It results to abdominal pains, diarrhoea, bloating gas, cramping and constipation. Irritable Bowel Syndrome has no permanent effect on the colon despite the uncomfortable symptoms and signs. Most individuals suffering from this disorder find that the symptoms get better as they learn to control the condition. A small number of individuals with this syndrome experience disabling symptoms and signs. Unlike other serious intestinal diseases like the Crohns disease and ulcerative colitis, this condition does not cause changes in the bowel tissue, inflammation, or increase an individual's risk of colorectal ulcer. One is about to control the syndrome in most cases through managing stress, diet and lifestyle (Baumgart, 2012).
This condition develops when a person's blood lack enough haemoglobin. This is the main section of the red blood cells, which also binds oxygen. The cells in the body fail to get enough oxygen, when one has abnormal or few red blood cells. Anaemia has symptoms that vary according to the cause, anaemia type and the health conditions such as ulcers, cancer, menstrual period or haemorrhage. The body has a remarkable ability of compensating for early anaemia as one may notice specific signs of those problems early (Baumgart, 2012).
When the anaemia has developed for a long period, one may not notice any signs. Symptoms that are common to many individuals suffering from anaemia include loss of energy, fatigue, rapid heartbeat especially with exercise, headache and shortness of breath. Others include pale skin, insomnia, difficult in concentration, dizziness and leg cramps Baumgart, 2012).
An individual experiences an unpleasant reaction to gluten in this common digestive system condition. When such an individual eats foods rich in gluten, he/she may trigger a range of signs such as passing wind, diarrhoea with an unpleasant smell, weight loss, abdominal pain and bloating. In addition, the individual feels tired at all times due to malnutrition and the level of growing in children becomes abnormal. Celiac disease symptoms can vary from mild to severe (Bayless & Hanauer, 2010).
The doctors arrived at the final diagnosis, which is Ulcerative Colitis from the signs and symptoms that the patient had. The disease had affected three fourth of his colon with a distortion of the colonic mucosa. Diarrhoea, bloody stool, loss of weight, low haemoglobin the patient had diarrhoea, bloody stool and low haemoglobin symptoms that strongly suggest severe destruction of the colon (Bayless & Hanauer, 2010).
Treatment plan including plans for teaching, follow-up and/or referral and primary/secondary/tertiary prevention
Ulcerative colitis treatment depends mainly on the extent to which the disease has affected a patient. It entails changes in diet and medicine. In the process of treating the colitis, one may also require to treat other diseases such as infection of anaemia. Its treatment relies on the initial medical management with anti-inflammatory and corticosteroids agents such as Sulfasalazine. This is in conjunction with rehydration and anti-diarrhoea agents along with symptomatic treatment. The patient results to surgery when there is failure of the medical treatment or in case of a surgical emergency such as the damage of the colon (Hanauer & Marteau, 2001).
There are various surgical options including ileostomy, reconstruction of the ileoanal pouch, colectomy or ileorectal anastomosis. In case of emergency, the recommended options are end-ileostomy or subtotal colectomy. There is an increase in the risk of getting carcinoma as it highly associates with chronic ulcerative. In some cases, it is easy not to detect the presence of colonic carcinoma in an ulcerative colitis setting. Patients who have ulcerative colitis should be aware of the risk of developing colon cancer. Doctors should encourage patients with non-acute cases to seek surgical intervention. This is in case the patients have refractory symptoms, have stayed with the disease for 10 years…[continue]
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This theme is further argued in the last chapter of the book, which presents a perspective into the future, with Queen Cockacoeske as a future Pocahontas, a future representative of her tribe in the relations with the English. The question that many of the indigenous people asked themselves, and this is extremely well presented in this book, is how to make this transition better and with as many benefits for