A 22-year-old male presents with a 4-month history of abdominal pain, particularly in the right lower quadrant, and persistent diarrhea, averaging 6-8 loose stools per day. He reports occasional blood in his stool and unintentional weight loss of about 10 pounds. He has been experiencing fatigue and night sweats. He has no significant past medical history but mentions that his father had similar gastrointestinal issues, which were diagnosed as Crohn's disease. The patient has tried over-the-counter loperamide with little relief. Physical Exam Findings: General: Appears fatigued but is in no acute distress Abdomen: Tenderness in the right lower quadrant, no rebound tenderness or guarding Rectal exam: Bright red blood on glove; stool is soft but not formed Initial Investigations: CBC: Mild anemia (low hemoglobin) CRP: Elevated Stool culture: Negative for pathogens Colonoscopy with biopsy is arranged to confirm diagnosis and assess for Crohn's disease. MCQs: What is the most appropriate next step in managing this patient? A) Start oral mesalamine B) Arrange for colonoscopy with biopsy C) Refer for surgical intervention D) Prescribe antibiotics What dietary modifications would you recommend to this patient? A) High-fiber diet B) Low-fat, easily digestible foods C) Avoid lactose and gluten D) Increase carbohydrate intake Which of the following medications is often used in the management of Crohn's disease? A) Corticosteroids B) Proton pump inhibitors C) Antispasmodics D) Loperamide Answers with Explanations: Answer: B) Arrange for colonoscopy with biopsy Explanation: Colonoscopy with biopsy is essential for diagnosing Crohn's disease and assessing the extent of inflammation and any complications. Answer: C) Avoid lactose and gluten Explanation: Patients with Crohn's disease often benefit from avoiding lactose and gluten, as these can exacerbate symptoms. Answer: A) Corticosteroids Explanation: Corticosteroids are often used in the management of active Crohn's disease to reduce inflammation during flare-ups. Overview of the Topic: Crohn's Disease Crohn's disease is an inflammatory bowel disease that can affect any part of the gastrointestinal tract. Key symptoms include abdominal pain, diarrhea (often bloody), and weight loss. Diagnosis is typically confirmed through endoscopy and biopsy. Initial management includes corticosteroids and dietary modifications tailored to the individual. Key Learning Points: Family history can be a significant factor in the diagnosis of Crohn's disease. Colonoscopy is the gold standard for diagnosis. Initial treatment often includes corticosteroids and dietary adjustments.
