874636

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Emily Johnson

874636

Emily Johnson

27 years old

Female

Attending

Dr. Linda Martinez

Insurance

Blue Cross Blue Shield

Emergency Contact

Sarah Thompson (Sister), XXX-555-9876

Chief Complaint

"I've had abdominal pain and diarrhea for the past two weeks. It’s been getting worse, and now I feel weak and nauseous."

Medical History

- Crohn's Disease: Diagnosed 5 years ago
- Iron Deficiency Anemia
- Seasonal Allergies
- Occasional Anxiety
- Multiple Hospitalizations for Crohn’s Flares

Allergies

Penicillin (Rash)
Nuts (Anaphylaxis)

1500

Patient appears fatigued and is lying in a fetal position. Reports 8/10 cramping pain in the lower abdomen and frequent diarrhea. Skin is dry and tenting noted on skin pinch test, indicating dehydration. No current signs of rectal bleeding.

IV access established with an 18-gauge catheter in the right forearm. Initial fluid bolus of normal saline administered.

1500

Suspected Diagnosis: Crohn's Disease Flare. The patient presents with a two-week history of increased abdominal pain, diarrhea (6-7 loose stools per day), nausea, and decreased oral intake. Given her history of Crohn's disease, her symptoms are consistent with an exacerbation. She has had previous flares managed with corticosteroids and biologic therapy. Plan includes hydration, pain control, and evaluation with labs and imaging

Active Orders

- IV Fluids: 0.9% Normal Saline 1L bolus, then 125 mL/hr maintenance
- Pain Management: Acetaminophen 650 mg PO, Morphine 2 mg IV for severe pain
- Antiemetic: Ondansetron 4 mg IV PRN for nausea
- Labs STAT:
- Complete Blood Count (CBC)
- Comprehensive Metabolic Panel (CMP)
- C-Reactive Protein (CRP)
- Erythrocyte Sedimentation Rate (ESR)
- Fecal Calprotectin
- Stool Culture & Ova/Parasites

Question 1

What does an elevated CRP level indicate in the context of Crohn’s disease?

Elevated CRP and Crohn's Disease: Elevated CRP indicates systemic inflammation, supporting the diagnosis of a Crohn’s flare.

Question 2

Why is it important to assess for dehydration in this patient?

Dehydration in Crohn’s: Frequent diarrhea can lead to fluid and electrolyte loss, making rehydration and monitoring essential.

Scroll to see what happens next

Emily Johnson

27 years old

Female

Attending

Dr. Linda Martinez

Insurance

Blue Cross Blue Shield

Emergency Contact

Sarah Thompson (Sister), XXX-555-9876

Chief Complaint

"I've had abdominal pain and diarrhea for the past two weeks. It’s been getting worse, and now I feel weak and nauseous."

Medical History

- Crohn's Disease: Diagnosed 5 years ago
- Iron Deficiency Anemia
- Seasonal Allergies
- Occasional Anxiety
- Multiple Hospitalizations for Crohn’s Flares

Allergies

Penicillin (Rash)
Nuts (Anaphylaxis)

0900 (Day 2)

Patient reports a slight decrease in abdominal pain (5/10). Diarrhea continues, though frequency reduced to 4-5 times/day. Abdominal exam reveals tenderness in the right lower quadrant. The patient is tolerating clear fluids. Continues to feel weak but is able to ambulate with assistance. Skin turgor improved, though patient is still mildly dehydrated.

Administered IV fluids and corticosteroid per provider’s order. Provided education on diet changes and the importance of medication adherence.

Question 3

Why are corticosteroids used during a Crohn’s disease flare?

Corticosteroid Use: Steroids are used for their anti-inflammatory properties to manage acute flares and reduce symptoms.

Question 4

What dietary modifications are recommended for patients with active Crohn’s disease?

Low-Residue Diet: This diet helps minimize intestinal volume, making it easier to tolerate during active inflammation.

Emily Johnson

27 years old

Female

Attending

Dr. Linda Martinez

Insurance

Blue Cross Blue Shield

Emergency Contact

Sarah Thompson (Sister), XXX-555-9876

Chief Complaint

"I've had abdominal pain and diarrhea for the past two weeks. It’s been getting worse, and now I feel weak and nauseous."

Medical History

- Crohn's Disease: Diagnosed 5 years ago
- Iron Deficiency Anemia
- Seasonal Allergies
- Occasional Anxiety
- Multiple Hospitalizations for Crohn’s Flares

Allergies

Penicillin (Rash)
Nuts (Anaphylaxis)

1100 (Day 4 )

Patient is comfortable and able to tolerate oral intake without nausea. Mild tenderness remains on abdominal exam but no signs of acute distress. Educated patient on tapering steroids and self-administration of adalimumab. Discussed follow-up appointments with gastroenterologist and dietitian. Provided contact information for support groups.

Monitored for side effects of medications, assisted with personal hygiene, and ensured discharge instructions were understood.

1100 (Day 4 )

The patient has shown significant improvement with decreased frequency of diarrhea (1-2 times/day) and resolution of nausea. Abdominal pain is minimal. She is tolerating a low-residue diet well. Will transition to oral prednisone with tapering schedule and continue adalimumab for long-term maintenance. Education provided on signs of flare recurrence, medication adherence, and follow-up.

Question 5

What is the rationale for tapering steroids instead of stopping them abruptly?

Steroid Tapering: Gradual reduction prevents adrenal insufficiency and supports a safe transition off corticosteroids.

Question 6

What long-term complications can occur if Crohn’s disease is not well managed?

Complications of Poorly Managed Crohn’s: Long-term complications can significantly impact the patient's quality of life and require surgical interventions in severe cases.

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