Inflammatory bowel diseases IBD Case presentation on Inflammatory bowel diseases

1. Presented by :
M.TEJASHREE
16Z11T0027
PHARM-D
4th yr
Case Presentation on
Inflammatory Bowel Diseases

2. INFLAMMATORY BOWEL
DISEASES
 DEFINATION:
 Inflammatory bowel diseases is group of intestinal disorders that cause
prolonged inflammation of digestive tract. It is a group of inflammatory
conditions of the colon and small intestine
 It is a spectrum of chronic idiopathic inflammatory condition.
 Epidemiology :
 In United states 1 – 1.3 million people suffer from IBD.
 Ulcerative colitis is slightly more common that in males.
 Crohn’s disease is more frequent in women's.

3. Normal view

4. IBD

5. CLASSIFICATION
 ULCERATIVE COLITIS :
 It is a disease that cause mucosal inflammation and
sores (ulcers) in lining of the large intestine (colon).
 CROHN’S DISEASE :
 It is a chronic, relapsing, and remitting inflammatory
disease of gastrointestinal tract and can effect any
part of mouth to anus.

7. Ulcerative colitis (UC)
 IT characterised by diffuse mucosal inflammation limited
to the large intestine.
 The extent of disease is divided into distal colitis which
affects the rectum (proctitis) or rectum and sigmoid
(rectosigmoiditis).
 UC may be more extensive than this and extend to the
left side of the colon (up as far as the splenic flexure) or
further on to the hepatic flexure.
 Colitis which involves the entire large colon is known as
pancolitis.

8.  Symptoms : loose bloody diarrhoea
 colicky abdominal pain
 tenesmus and urgency
 The disease always involves the rectum and is
characterised by relapses and remission.
 The patient only the mucosa is affected.

9. Crohn’s disease
 Crohn’s disease may affect any part of the
gastrointestinal tract from the mouth to the anus.
 It is characterised as patchy, transmural inflammation.
 The mucosa may demonstrate a cobblestone
appearance in severe ulceration and the bowel may
show areas of inflammation interspersed with areas of
healthy bowel described as skip lesions.
 It may present at any age but usually presents between
the age of 15-40 years and affects males or females.
 It is twice as common in smokers as non-smokers;
stopping smoking reduces the risk of relapse
 Need for immunosuppression and surgery.

10.  Symptoms : anorexia, malaise, fever, tachycardia,
weight loss, abdominal pain and diarrhoea.
 Diagnosis : can be difficult to make as other
conditions may also cause these symptoms.
 Therefore a combination of endoscopic, radiological
and blood test are needed to confirm the diagnosis.
 The condition is also classified according to site,
extent, and pattern of disease.
 This then influences the medical management,
likelihood of surgery and prognosis.

13. Ethiology
 Diet
 Dietary patterns are associated with a risk for ulcerative colitis.
 A diet high in protein, particularly animal protein, may be associated
with increased risk of inflammatory bowel disease and relapses.
 IMMUNITY :
 IBD may result when an abnormal immune system response to
bacteria, viruses, or food particles, triggers an inflammatory reaction in
the gut.
 Genetics:
 Links have been discovered between IBD and certain gene mutations.
 Bacteria or viruses:
 Research has linked both E.coli and enteroviruses to Crohn's disease.
 Environmental:
 Factors such as smoking, oral contraceptives, diet, breastfeeding,

14. Risk factors
 Age: most people are diagnosed before age 30.
 Genetics: People with a close relative with IBD are at
higher risk.
 Location: People living in urban areas and in
industrialized countries are more likely to be diagnosed
with IBD.
 Medications: Use of certain medications, such as
isotretinoin or nonsteroidal anti-inflammatory medications
may increase the risk.

15. Pathophysiology

17. Laboratory investigation
Ulcerative colitis Crohn’s diseases
 ESR levels elevated
 Hyperalbuminea
 Anemia
 Electrolyte imbalance
 Lucocytosis
 ESR level elevated
 Hyperalbuminea
 Anemia

18. Subjective data
 Patient name : XXXX
 Age/gender : 17/F
 Admission no : 190111236
 DEPT : G FMW-2
 Date of admission : 11/7/19
 Date of discharge : 17/7/19
 Chief complaints : She complained of a perianal
pain and had noticed a continuous drainage of
muco-purulent fluid from a tiny sinus around her
back passage, often get up to toilet three to four
times at night.
 abdominal pain was very severe.

19.  PRESENT ILLNESS : She appeared pale, tired
 looking and had a low body mass index.
 PAST MEDICAL HISTORY : six-month history of
anorexia, weight loss, right-sided abdominal pain,
diarrhoea associated with urgency and fatigue.
 PERSONAL HISTORY : Her mother
 said her older brother Crohn’s disease
 and had presented in a similar way.
 EXAMINATION : found tenderness and guarding on the
LUMP on right side in particular a palpable mass on
examination.
 VITALS :
 TEMP – 101 F
 PR : 90bpm
 Bp : 110/70
 RR : 22 cpm

20. Lab reports
vitals Day 1 Day 2 Day 3
Pulse rate 90bpm 88 80
Bp mm/Hg 110/70 100/70 110/70
temp 101 100 100
RR cpm 22 20 20

21. parameters 11/7/19 12/7/19 18/7/19 Normal range
WBC 9800mil/cumm 8800mil/cumm 8000mil/cumm 4000-11000
N 73% 70% 70% 40-80%
L 30% 29% 23% 20-40%
M 3% 3% 2% 2-10%
E 3% 3% 2% 1-6%
ESR 65mm/hr 60mm/hr 5mm/hr 0-25mm/hr
Haemoglobin 10gm/dl 10.1gm/dl 11.1gm/dl 12-15gm/dl
S.Creatinine 2mg/dl 2mg/dl 1.5mg/dl 0.5-1.2mg/dl
RBC 3.45cmm 3.5cmm 4cmm 4.3cmm
PLATLETS 650,000/L 405,000/L <450,000/L
Sr ALBUMIN 38g/dl 22g/dl 10g/dl 3.4-5.4g/dl
Na+ 133meq/l

22. Investigations
 MICROBIOLOGICAL INVESTIGATION
 Stool samples were sent for microbiological testing
for infectious diarrhoea including clostridium difficile
toxin.
 COLONOSCOPY
 In order to visualise the ileum a colonoscopy with a
terminal ileoscopy was performed.
 There was evidence of patchy erythema and a small
fistula in the rectum.
 The large colon was normal.
 There was also evidence of ulceration in the terminal
ileum.

23. Assessment
 Inflammatory bowel diseases
 “Crohns diseases”

24. Treatment chart
s
n
o
Brand name compositio
n
DOS
E
FRECY RO
A
INDICATI
ON
SIDE
EFFECT
S
DATE
1 REMICADE Infliximab 5mg/k
g at
0,2,6
OD IV fistula
healing
Headach
e,
stomach
pain
11/9-
17/9
2 ADFRAR adalimuma
b
40mg OD SC Crohn
disease
headach 11/9-
17/9
3 CORDOL hydrocortis
one
100m
g
6th hr IV Inflammat
ion
insomnia 11/9-
14/9
4 METROGYL metronidaz
ole
500m
g
TID PO fistulising
Crohns
disease.
Vaginitis
headach
14/9-
17/9
5 CASPRO ciprofloxaci
n
500m
g
BD PO fistulising
Crohns
disease.
dizziness 14/9-
17/9

25. sno Brand
name
Chemical
compositi
on
dos
e
frency
eq
ROA indicatio
n
Side
effects
dates
6 VITAFOL Folic acid 5mg OD PO anaemia Gastric
Disturba
nces
11/9-
17/9
7 T.BECOSU
LES
Multi vit 150
mg
OD PO Vitamin
supply
constipa
tion
11/9-
17/9
8 T.DOLO paracetmo
l
650
mg
BD PO fever headach
e
11/9-
17/9
9 PAN pantapraz
ol
40m
g
BD PO Headach
e
Abd
pain
11/9-
17/9

26. Day to day progress
 Day 1 :
 Complaints : appeared pale, tired,
stools in 2 episodes
 vitals
 Pulse rate - 90bpm
 Bp 110/70 mm/Hg
 Temp : 101F
 RR 22cpm
 Medication :
 REMICADE - OD,IV
 ADFRAR 40mg OD SC
 CORDOL 650mg BD PO
 VITAFOL
 T.BECOSULES
 T.DOLO
 PAN
 Day 2:
 complaints : bowels as opening twice a
day, semi-solid stool consistency, with
no visible blood in the stool.
 Vitals:
 Pulse rate - 80bpm
 Bp 100/70 mm/Hg
 Temp : 100F
 RR : 20cpm
 Medications :
 CST
 METROGYL 500mg TID,PO
 CASPRO 500mg,BD,PO

27.  Day 3 :
 Complaints : right side
had abated the
abdominal
 pain and diarrhoea
remained.
 Vitals:
 Pulse rate - 80bpm
 Bp 100/70 mm/Hg
 Temp : 100F
 RR : 20cpm
 Medications :
 Day 4 :
 Complaints : Nill
 Vitals:
 Pulse rate - 80bpm
 Bp 100/70 mm/Hg
 Temp : 100F
 RR : 20cpm
 Medications :
 CST

28. Pharmacist interventions
 METRONIDAZOLE = ACETAMINOPHEN
 It is minor.
 Metronidazole will increases the level or effect of
acetaminophen by affecting hepatic enzyme
CYP2E1 metabolism.

29. Discharge summary
 She had gained 6kg and was feeling much better.
 The perianal fistula had closed and she had no further
episodes of abdominal pain.
 Her energy levels had improved with her appetite.
 Treatments are aimed at optimising medical
management and minimising the risk of complications.
 Infliximab may result in rapid mucosal healing.
 Discharge medication:
 T.BECOSULES OD
 T.REMECADI 250mg BD

30. Life style modifications
 Follow a low residue diet to relieve abdominal pain and
diarrhea.
 avoid nuts, seeds, beans and kernels.
 Avoid foods that may increase stool output such as
fresh fruits and vegetables, prunes and caffeinated
beverages. Cold foods may help reduce diarrhea.
 Dietary intake milk, fibre, and sugar.
 High refined carbohydrate intake.
 Avoid Oral contraceptives
 If you have lactose intolerance, follow a lactose-free
diet. Lactose intolerance causes gas, bloating,
cramping and diarrhea 30 to 90 minutes after eating
milk, ice cream or large amounts of dairy.
 If your appetite is decreased and solid foods not

31. Thanking you