This document presents a case study on inflammatory bowel diseases. It provides definitions and classifications of inflammatory bowel diseases, specifically ulcerative colitis and Crohn's disease. It describes the symptoms, risk factors, laboratory findings, investigations, assessments, treatment and lifestyle modifications for a 17-year-old female patient admitted with complaints of perianal pain and drainage who was diagnosed with Crohn's disease. Her symptoms improved with medical treatment including infliximab and she was discharged on a low residue diet and continuing medications.

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