Kevin: Ulcerative Colitis & Anemia
Kevin is an 18 y/o college student who presents to the College Health Clinic reporting increased fatigue over the past several weeks. He is concerned because he is unable to keep up with his course work. He is a thin young man who appears pale. He reports no history of medical problems or surgeries. He takes no medications. He denies use of marijuana or recreational drugs. He is a long-distance runner, but lately unable to run secondary to fatigue. He reports smoking cigarettes 1 ppd for 3 years.
The Health Care Provider completes a review of systems (ROS) to obtain a complete health history & that finds that Bryan reports having intermittent various GI issues for the past 6 months, which at times include diarrhea-sometimes including a fair amount of blood. He reports that he was anxious starting college & thought it was related to that.
Pre-College PE: Height 6’0”, Weight 189 lbs (89.5 kg) BMI 25.96
Today: Vital Signs: BP 128/76, HR 102, RR 20, POX 95% RA, Temp 98.6, Height 6’0”, Weight 165 lbs (75 kg), BMI 22.64
Physical Assessment: Neuro A & x3; Lungs breath sounds clear; Heart Sounds regular, tachycardic; Abd soft, tender to touch, nondistended, hyperactive bowel sounds; Extremities PP+, no edema.
Labs are drawn & Bryan returns the next day. He is told he is anemic, & probably has developed ulcerative colitis.
Labs:
WBC 6.1
Hemoglobin 11.3
Hematocrit 28%
Platelets 210,000
NA 138
K 4.2
BUN 16.4
Cr 1.2
Glucose 102
Please respond to Questions by number & in order listed here. Scholarly references are required.
1. Review & contrast the pathophysiology & clinical manifestations of Ulcerative Colitis & Crohns.
2. Why is Bryan anemic?
3. What type of anemia do you think he has? And why?
4. What diagnostic test(s) should be ordered to confirm the Ulcerative Colitis diagnosis?
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