Inflammatory Bowel Disease and Urinary Obstruction Case Studies
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Inflammatory Bowel Disease and Urinary Obstruction Case Studies
Case Study:
Inflammatory Bowel Disease
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 glucose) Small bowel series, Constriction of multiple segments of the small intestine
Diagnostic Analysis
The child’s 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
- Why was this patient placed on immunosuppressive therapy?
- Why was the Meckel scan ordered for this patient?
- What are the clinical differences and treatment options for Ulcerative Colitis and Crohn’s Disease? (Always on boards)
- What is prognosis for patients with IBD and what are the follow up recommendations for managing disease?
Case Studies
Urinary Obstruction
The 57-year-old patient noted urinary hesitancy and a decrease in the force of his urinary stream for several months. Both had progressively become worse. His physical examination was essentially negative except for an
enlarged prostate, which was bulky and soft.
Studies Results Routine laboratory studies Within normal limits (WNL) Intravenous pyelogram (IVP) Mild indentation of the interior aspect of the bladder, indicating an enlarged prostate Uroflowmetry with total voided flow of
225 mL 8 mL/sec (normal: >12 mL/sec) Cystometry Resting bladder pressure: 35 cm H2O (normal: <40 cm H2O) Peak bladder pressure: 50 cm H2O (normal: 40-90 cm H2O) Electromyography of the pelvic sphincter muscle
Normal resting bladder with a positive tonus limb Cystoscopy Benign prostatic hypertrophy (BPH) Prostatic acid phosphatase (PAP) 0.5 units/L (normal: 0.11-0.60 units/L) Prostate specific antigen (PSA) 1.0 ng/mL (normal: <4
ng/mL) Prostate ultrasound Diffusely enlarged prostate; no localized tumor
Diagnostic Analysis
Because of the patient’s symptoms, bladder outlet obstruction was highly suspected. Physical examination indicated an enlarged prostate. IVP studies corroborated that finding. The reduced urine flow rate indicated an
obstruction distal to the urinary bladder. Because the patient was found to have a normal total voided volume, one could not say that the reduced flow rate was the result of an inadequately distended bladder. Rather, the bladder
was appropriately distended, yet the flow rate was decreased. This indicated outlet obstruction. The cystogram indicated that the bladder was capable of mounting an effective pressure and was not an atonic bladder compatible
with neurologic disease. The tonus limb again indicated the bladder was able to contract. The peak bladder pressure of 50 cm H2O was normal, again indicating appropriate muscular function of the bladder. Based on these
studies, the patient was diagnosed with a urinary outlet obstruction. The PAP and PSA indicated benign prostatic hypertrophy (BPH). The ultrasound supported that diagnosis. Cystoscopy documented that finding, and the patient
was appropriately treated by transurethral resection of the prostate (TURP). This patient did well postoperatively and had no major problems.
Critical Thinking Questions
- Does BPH predispose this patient to cancer?
- Why are patients with BPH at increased risk for urinary tract infections?
- What would you expect the patient’s PSA level to be after surgery?
- What is the recommended screening guidelines and treatment for BPH? 5. What are some alternative treatments / natural homeopathic options for treatment?
Inflammatory Bowel Disease and Urinary Obstruction Case Studies
RUBRIC
Excellent Quality
95-100%
Introduction 45-41 points
The background and significance of the problem and a clear statement of the research purpose is provided. The search history is mentioned.
Literature Support
91-84 points
The background and significance of the problem and a clear statement of the research purpose is provided. The search history is mentioned.
Methodology
58-53 points
Content is well-organized with headings for each slide and bulleted lists to group related material as needed. Use of font, color, graphics, effects, etc. to enhance readability and presentation content is excellent. Length requirements of 10 slides/pages or less is met.
Average Score
50-85%
40-38 points
More depth/detail for the background and significance is needed, or the research detail is not clear. No search history information is provided.
83-76 points
Review of relevant theoretical literature is evident, but there is little integration of studies into concepts related to problem. Review is partially focused and organized. Supporting and opposing research are included. Summary of information presented is included. Conclusion may not contain a biblical integration.
52-49 points
Content is somewhat organized, but no structure is apparent. The use of font, color, graphics, effects, etc. is occasionally detracting to the presentation content. Length requirements may not be met.
Poor Quality
0-45%
37-1 points
The background and/or significance are missing. No search history information is provided.
75-1 points
Review of relevant theoretical literature is evident, but there is no integration of studies into concepts related to problem. Review is partially focused and organized. Supporting and opposing research are not included in the summary of information presented. Conclusion does not contain a biblical integration.
48-1 points
There is no clear or logical organizational structure. No logical sequence is apparent. The use of font, color, graphics, effects etc. is often detracting to the presentation content. Length requirements may not be met
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