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Oct 25, 2021
  • The patient is an 11-year-old girl who has been complaining of intermittent right lower
    quadrant pain and diarrhea for the past year. She is small for her age. Her physical
    examination indicates some mild right lower quadrant tenderness and fullness.
    Studies Results
    Hemoglobin (Hgb), 8.6 g/dL (normal: >12 g/dL)
    Hematocrit (Hct), 28% (normal: 31%-43%)
    Vitamin B12 level, 68 pg/mL (normal: 100-700 pg/mL)
    Meckel scan, No evidence of Meckel diverticulum
    D-Xylose absorption, 60 min: 8 mg/dL (normal: >15-20 mg/dL)
    120 min: 6 mg/dL (normal: >20 mg/dL)
    Lactose tolerance, No change in glucose level (normal: >20 mg/dL rise in
    Small bowel series, Constriction of multiple segments of the small intestine
    Diagnostic Analysis
    The childs small bowel series is compatible with Crohn disease of the small intestine.
    Intestinal absorption is diminished, as indicated by the abnormal D-xylose and lactose
    tolerance tests. Absorption is so bad that she cannot absorb vitamin B12. As a result, she has
    vitamin B12 deficiency anemia. She was placed on an aggressive immunosuppressive
    regimen, and her condition improved significantly. Unfortunately, 2 years later she
    experienced unremitting obstructive symptoms and required surgery. One year after surgery,
    her gastrointestinal function was normal, and her anemia had resolved. Her growth status
    matched her age group. Her absorption tests were normal, as were her B12 levels. Her
    immunosuppressive drugs were discontinued, and she is doing well.
    Critical Thinking Questions
    1. Why was this patient placed on immunosuppressive therapy? 2. Why was the Meckel scan ordered for this patient? 3. What are the clinical differences and treatment options for Ulcerative Colitis and Crohns
    Disease? (always on boards)
    4. What is prognosis for patients with IBD and what are the follow up recommendations for managing disease?

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