Evaluation and diagnosis of severe ulcerative colitis in an adolescent

Ulcerative Colitis

Initial presentation

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.

Historical information

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.

Presenting Symptoms

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.

Pertinent history

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.

Procedure

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.

Recommendation

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

Crohns disease

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).

Ulcerative Colitis

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).

Anaemia

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).

Celiac disease

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).

Follow-up visits

The doctor will ensure that the patient follows-up visits approximately every 6 months while the patient's condition is stable. It is essential for the patient to see the doctor frequently when having problems. Many patients are familiar with their problems that they have the capability of handling minor outbreaks on their own, but in some cases, it is necessary to consult the doctor even when the case is minor (Bayless & Hanauer, 2010).

Prevention

There is no possible way to prevent ulcerative colitis since its cause is unknown. However, some patients have the capability of reducing the frequency of its symptoms. They do this through avoiding various foods such as milk products or spicy foods. If one has ulcerative colitis, he/she can decrease the effect it has on the body. This is possible through eating a nutritious and well balanced- diet. It is essential to store up nutrients and vitamins even amid symptomatic episodes. This enables the patient to decrease the complications that arise from malnutrition such as low blood count and loss in weight (Hanauer & Marteau, 2001).

Ulcerative colitis enhances the risk of colon cancer. Individuals who have extensive inflammation in the entire colon have the greatest risk. It is; therefore, essential to have ones colon checked regularly for early symptoms of cancer. The patient should inquire from the doctor how often they should undergo a colonoscopy. Poor nutrition or medications that a colitis patient takes also have side effects. They may lead to osteoporosis a disease, which weakens the bones thus causing them to break. It is possible to prevent osteoporosis using medicine, vitamin D, adequate exercise and calcium. When people have ulcerative colitis, it is essential for them to discuss osteoporosis their doctor (Hanauer & Marteau, 2001).

Review briefly the pathophysiology of diagnosis

The doctors were able to confirm the diagnosis of ulcerative colitis through blood tests and colonoscopy. When the patient visited the office, the doctor took his blood sample, which showed the following results 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). The test was essential as it may help in checking for infection, and the bowel disease. The patient also underwent colonoscopy. This examination enables the doctor to view a patient's entire colon with the use of a thin, flexible lighted tube that has a camera attached to it. During the procedure, the doctor took a small sample of the colon for laboratory analysis, as the tissue is sometimes necessary for the confirmation of diagnosis.

Discuss management options. Integrate research-based interventions & standards of care.

Management is essential for patients with acute illnesses such as ulcerative colitis. Currently, there is no evidence, which shows that a patient with ulcerative colitis improves his/her enhances of survival when he/she undergoes regular endoscopic screening. However, practices that many current standard gastroenterologists have continue to screen these patients at a certain interval due to the risk of developing cancer and the possibility of legal implications. It is easy to manage this disease through secondary care with regular outpatient reviews, which specialist clinicians carry out (Robinson et al., 2001).

Alternatively, the doctor can discharge the patient to a primary care or provide for them open access clinics. According to a research randomly carried out on 203 patients, self-management of patients with this disease reduces the provision of treatment and visits to the doctors but fails to increase mobility. This approach is essential for use in long-term management of other chronic diseases as it improves the provision of health services, and reduces the cost (Robinson et al., 2001).

Describe special considerations pertinent to the case e.g. culture, gender, age etc., and describe how care would be different within other groups.

Ulcerative colitis has effects almost on the same number of men and women. The risk factors entail age, family history and race or ethnicity among others. Ulcerative colitis normally begins before 30 years of age. In some cases, it may take place at any age with some people developing the disease when they are in their 50s or 60s. An individual has a high risk of developing the disease if he/she has a close relative with the disease. Even though, the whites have the greatest risk of getting the disease, it is possible for it to arise in any area, as the risk is also high for Ashkenazi Jewish descents (Hanauer & Marteau, 2001).