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Discussion in 'Case Studies' started by maltman2011, Feb 15, 2013.

  1. maltman2011

    maltman2011 Well-Known Member

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    a17years old female diagnosed as acse of coeliac disease+bowel inflammatory disease(chrons)-on gluteen free diet +azathiopurine 1000mg od+mv-she stopped her azathioprine without knowledge of her doctor-from 5 days she was c\o abdominal pain-severe nausea-severe backache-neck pain not improving by injectable steroids-no pain-iv fluid-buscpan-what is possible diagnosis and management.
     

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  2. neo_star

    neo_star Moderator

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    Rule out

    - exacerbation of her primary condition i.e Crohn's
    - think of other causes of acute abdomen ( appendicitis, ac. pancreatitis, stones ( kidney and gall bladder ), and perforation esp. from Crohn's
    - rule out subacute intestinal obstruction from strictures
    - rule out meningitis ( both septic and aseptic )
    - note: certain drugs can cause aseptic meningitis ( ex. brufen and Azathioprine ). Since she has stopped azathioprine that may not be the cause in her case. Brufen is esp. notorious for causing aseptic meningitis in SLE patients.
    - rule out acute intermittent porphyria

    Note: The perforation may be very small and buried in the mucosa that it may not be visible on colonoscopy...so u hav to do a CT and look for any collection ( the CT will not show a perforation, but any adhesion or matting of intestines or any fluid collection will point towards a perforation )

    I hope ur patient does well. (Y)

    Keep us posted

    p.s Additionally since Crohn's can affect anywhere from mouth to anus ....do a gastroduodenoscopy to rule out any upper gi ulcerative process and start a trial of Proton pump inhibitors, irrespective of the findings.

    Stat CT abdomen and pelvis is must....becos u don't want a septicemia ( hot potato ).
     

    Last edited: Feb 20, 2013
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  3. anshu

    anshu Guest

    hey thnx joey for the answer and also,for this link nd forum.
    :)
     

  4. neo_star

    neo_star Moderator

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    u r welcome anshu and kindly contribute to making this place better (-:
     

  5. medico

    medico Young Member

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    desde m punto de vista es un caso de pancreatitits
     

  6. Bouheraoua

    Bouheraoua Famous Member

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