Case Presentation on:

CROHN'S DISEASE

Reg.no: 381810013
PATIENT DEMOGRAPHIC DETAILS:

• Patient Name: Mr.Z

• Sex: Male
• Age: 54 years
• DOA: 5/3/2022
• DOD: 8/3/2022
SUBJECTIVE EVIDENCE:

Chief complaints of:

• Diarrhea for more than 6 times a day with
blood and mucus.
• Fatigue
• Abdominal cramps
• Fever × 4 days
• Weight loss
Past Medical History:
• Ulcerative Colitis - 8 years ago.

Past Medication History:

• Mesalazine
• Pepto Bismol

SOCIAL HISTORY: Alcoholic & Smoker

ALLERGIES(if any): NIL.
OBJECTIVE EVIDENCE:
GENERAL EXAMINATION:
The Patient was conscious and afebrile.
• VITAL SIGNS:
PARAMETER OBSERVATION NORMAL RANGE
Blood Pressure 100/70 mmHg Less than 120/80 mmHg
Heart Rate 83 beats/min 60-100 beats/min
Respiratory Rate 18 breath/min 12-18 breath/min
Temperature 98.6°F 97-99°F
• PHYSICAL EXAMINATION:
• CVS: S1S2+

•RS: BAE+

•P/A: Soft

•CNS: NFND
LABORATORY INVESTIGATIONS:

• CLINICAL HEMATOLOGY:
PARAMETER OBSERVED VALUE NORMAL RANGE

Hemoglobin (Hb) 11 g/dl 14-18 g/dl

Polymorphs 42% 40-60%
Lymphocytes 25 % 20-40%
Eosinophils 4% 0-5%
Monocytes 3% 4-8%
Basophils 0.1 % 0-1 %
Platelet Count 1.2 L cells/mm3 1.5-4L cells/mm3
Red Blood Cells/RBC’s 3.9*106 cells/mm3 4.5-6 *106 cells/mm3
PARAMETER OBSERVED VALUE NORMAL RANGE

Total Count 3*103 cells/mm3 4-10*103 cells/mm3

Packed Cell Volume/PCV 37.7 % 38-54%
Mean Cell Volume/MCV 88 µm3 80-100µm3
Mean Cell Hemoglobin/MCH 27.5 pg/cell 27-33 pg/cell
Mean Cell Hemoglobin Concentration (MCHC) 30 g/dl 33-37g/dl
Erythrocyte Sedimentation Rate/ESR 48 mm/hr <20 mm/hr
PARAMETER
BIOCHEMISTRY:
Electrolytes:
OBSERVATION NORMAL RANGE
Sodium 140 mmol/L 135-145 mmol/L
Potassium
Lipid Profile:
3.9 mmol/L 3.5-5 mmol/L
Calcium 2.3 mmol/L 2.2-2.6 mmol/L

PARAMETER OBSERVATION NORMAL RANGE

Cholesterol 220 mg/dl <225 mg/dl
Triglycerides 120 mg/dl 50-150 mg/dl
Low Density Lipoprotein (LDL) 105 mg/dl 85-125 mg/dl
High Density Lipoprotein (HDL) 75 mg/dl 40-80 mg/dl
LIVER FUNCTION TESTS:

PARAMETER OBSERVATION NORMAL RANGE

Total Protein 5.2 g/dl 6.3-8.0 g/dl
Albumin 4.7 g/dl 3.5-5.5 g/dl
Globulin 5.7 g/dl 1.5-3.5 g/dl

BLOOD SUGAR:
PARAMETER OBSERVATION NORMAL RANGE

Fasting/(FBS) 100 mg/dl 60-110 mg/dl

Postprandial/(PPBS) 90 mg/dl 80-140 mg/dl
Random/(RBS) 75 mg/dl 70-140 mg/dl
OTHER INVESTIGATIONS:

• Video endoscopy : Acute combined

hemorrhoids and fissures are present.
• ILeocolonoscopy :Segmental pattern of
involvement.
• Macroscopic finding :Cobble-stone sign, linear
ulcer
ASSESSMENT:
• Based on The Subjective and
Objective Evidence The Patient
was diagnosed to have
‘CROHN'S DISEASE’.
 PLAN:

DRUG NAME DOSE ROUTE FREQUENCY DURATION (DAYS)

1 2 3 4
BRAND GENERIC
T. Prednisolone Prednisolone 40mg PO 0-0-1 ✓ ✓ ✓ ✓
T. Asacol Mesalazine 400mg PO 0-0-1 ✓ ✓ ✓ ✓
T. Folvite Folic acid 5mg PO 1-0-1 ✓ ✓ ✓ ✓
T. Loparet Loperamide 2mg PO 1-0-1 ✓ ✓ ✓ ✓
T.Neurobion Vit B1,3,5,10,12 15mg PO 1-0-1 ✓ ✓ ✓ ✓
Forte
T. Metrogyl Metronidazole 40mg PO 1-0-1 ✓ ✓ ✓ ✓
T. Paracip Paracetamol 650mg PO 1-0-1 ✓ ✓ ✓ ✓
DNS Glucose Sodium 25% in I.V ✓ ✓ ✓ ✓
500 ml infusion
 DRUGS ON DISCHARGE:
DRUG NAME DOSE ROUTE FREQUENCY DURATION
BRAND GENERIC
T. Folvite Folic acid 5mg PO 1-0-1 1 week
T. Loparet Loperamide 2mg PO 1-0-1 SOS
T.Neurobion Vit B1,3,5,10,12 15mg PO 1-0-1 1 week
Forte
T. Paracip Paracetamol 650mg PO 1-0-1 SOS
T. Metrogyl Metronidazole 40mg PO 1-0-1 3 days

DRUG INTERACTIONS: 6 minor or non-significant drug

interactions were found.
PHARMACIST INTERVENTION:
Mesalamine may be replaced with Sulphasalazine & Ciprofloxacin
can be given instead of or together with Metronidazole according
to the ACG (American College of Gastroenterology) Clinical
Guideline for Management of Crohn’s disease in Adults.
PATIENT COUNSELLING:
REGARDING DISEASE:
• Crohn's disease is a type of inflammatory bowel
disease (IBD). It causes inflammation of your digestive
tract, which can lead to abdominal pain, severe
diarrhea, fatigue, weight loss and malnutrition.
REGARDING DRUGS:
• T. Asacol should be taken on an empty stomach, 30
minutes before or 2 hours after food.
• Avoid NSAIDS such as Naproxen or Ibuprofen as they
might worsen the disease.
REGARDING LIFESTYLE MODIFICATIONS:
• Reduce the amount of oily and fried food in
your diet, which may cause diarrhea.
• Sugary beverages, coffee, tea, cold liquids
should be avoided.
• Tomato juice & ORS can be taken.
Review: after 2 weeks
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