Question

Mrs. G is a 60-year-old female who presented to the emergency department complaining of severe periumbilical abdominal pain for the past four hours. As the pain continued to worsen, the patient experienced nausea, vomiting, and diarrhea. Mrs. G has a past medical history which includes hypertension, Crohn’s disease (for the past 12 years), and gastroesophageal reflux disease (GERD). Mrs. G reported that the onset of the pain had increased and became more severe over the past few hours. She additionally described nausea, vomiting, and diarrhea that began about two hours prior to the arrival to the emergency department. The emesis was described as bile-like in nature. The diarrhea was described as liquid brown with some bright red blood noted. Mrs. G admitted to being at a barbecue the evening prior and having consumed two pieces of corn on the cob.

Upon exam, Mrs. G complained of pain level 8 out of 10 throughout her periumbilical region with tenderness and guarding noted hyperactive bowel sounds were noted in all four quadrants. Mrs. G was febrile with a temperature of 100.4°F tympanic, had a pulse 124 bpm and regular respirations at 20, her blood pressure was 170/90 with an O2 saturation of 98% on room air. Her lungs were clear to auscultation, however poor inspiratory effort was noted. Peripheral venous access and labs were obtained.

Mrs. G’s current medications include Diovan 320 mg by mouth daily, hydrochlorothiazide 12.5 mg daily, atenolol 25 mg by mouth daily, Prilosec 20 mg by mouth daily and Humira pen 40 mg every other week for her Crohn’s disease.

Mrs. G’s initial labs reveal the white blood cell count of 14,000 with 7% bands, sodium 142, potassium level 2.8, magnesium 1.6, and creatinine 1.31 with BUN of 38.

QUESTION:

Based on this patient’s presentation and history, what would you assume to be wrong with this patient.

Answer 1

An acute exacerbation or acute increase in the severity of the patient's Crohn's disease was suspected, the barbecue the evening prior and having consumed two pieces of corn on the cob could have precipitated this condition. People with Crohn's disease will find it hard to digest certain foods like corn

Crohns disease.causes inflammation of your digestive tract, which can lead to abdominal pain, severe diarrhea, fatigue, weight loss and malnutrition. Inflammation caused by Crohn's disease can involve different areas of the digestive tract in different people, all the above symptoms are typical of crohns disease.