University Patient Case Study: Crohn's Disease Diagnosis and Analysis

This case study presents a detailed analysis of Mr. Bob Jackson, a 55-year-old male patient exhibiting symptoms of diarrhea, nausea, and malaise. The study explores the potential diagnosis of Crohn's disease, examining the patient's symptoms, pathological reports, and physiological parameters. It investigates the aetiological and pathophysiological evidence supporting the diagnosis, considering factors like beer consumption, nutritional deficiencies, potential bacterial infections (Mycobacterium avium paratuberculosis), and prolonged use of NSAIDs. The case study then delves into the symptoms and the differential diagnosis between Crohn's disease and Ulcerative Colitis, highlighting the importance of tests such as ultrasonography and bacterial cultures to confirm the diagnosis and differentiate between the two Inflammatory Bowel Diseases. Finally, it provides references to support the findings.

Running head: PATIENT CASE STUDY
Patient Case Study
Name of the Student
Name of the University
Author Note

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PATIENT CASE STUDY
Table of Contents
Part 1...........................................................................................................2
Part 2...........................................................................................................5
References..................................................................................................7

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PATIENT CASE STUDY
Patient Case Study
Patient details
 Name of the Patient: Mr. Bob Jackson
 Age: 55 years
 Sex: Male
 Symptoms: Diarrhea, Nausea and Malaise
Part 1
After reviewing the symptoms, pathological reports and
physiological parameters, it seems that Mr. Bob Jackson is suffering from
Crohn’s disease. Crohn’s disease is defined as a condition of idiopathic
inflammation of any part of the gastrointestinal tract (starting from the
mouth to anus). Although, maximum reported cases shows ileocaecal
occurrence. It is one of the most common diseases encountered in the
domain of gastroenterology and falls under the category of the
Inflammatory Bowel Disease (IBD) (Baumgart & Sandborn, 2012).
Aetiological Evidence of Mr. Jackson with Crohn’s Disease
The major leading cause behind the occurrence of the Crohn’s
disease is uncontrolled inflammation. This uncontrolled inflammation
of the gastrointestinal tract may occur because of beer consumption.
Mr. Jackson, consumes 6 stubbies of beer per week such high beer
consumption rate at the age of 55 might have resulted in the
inflammation of the gastrointestinal tract, leading to Crohn’s disease
(Manninen et al., 2012). Another excepted cause behind developing
susceptibility towards Crohn’s disease is nutritional deficiencies. Mr.
Jackson resides in a rural community (100 Km northwest from Melbourne)
and people of the rural community lack nutrition in diet, leading to the
arrival of the stigma of the Crohn’s disease (Kyle, 2013).
One of the most important bacterial threats stated so far behind the
occurrence of the Crohn’s disease is Mycobacterium avium
paratuberculosis. Recent research conducted by Traveria et al., (2013)

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identified the existence of Mycobacterium avium paratuberculosis in the
sheep. Mr. Jackson is a sheep farmer by occupation at the Paterson’s
Plains in Australia. His job profile demands close association with the
sheep and during his duty hours, the bacteria Mycobacterium avium
paratuberculosis might have got transfused into his blood steam via food
or via cut and leading to the development of the Crohn’s disease.
The prolong use of the Non Steroidal Anti-inflammatory Drugs
(NSAIDs) make a person susceptible for the development of the Crohn’s
disease. Mr. Jackson, has been on the medication with Ibuprofane for
nocturnal bone pain in hips and back. This prolong use of this NSAIDs
might made Mr. Jackson develop Crohn’s disease (Ananthakrishnan et al.,
2012).
Pathophysiological Evidence of Mr. Jackson and its relation to
Crohn’s Disease
Examination of the gastro-intestinal tract of Mr. Jackson noted
lower abdominal distension. In the majority of the cases, people who
are suffering from the Crohn’s disease tend to consume less food in order
to avoid the excretion of the watery stool or due to lack of appetite. This
empty stomach leads to the formation of wind and leading to abdominal
distension. Moreover, Crohn’s disease classified with crypt inflammation
in the gastrointestinal tract, mostly in the lower part of the small
intestine or colon. Such inflammation in the lower part of the abdomen
can result in the development of the lower abdominal distention.
The transmural spread of the inflammation in the gastrointestinal
tract leads to the generation of the lymphedema, which is followed by the
thickening of the stomach wall and mesentery. This thickened mesenteric
fat y extends up to the serosal surface of the bowel causing Mr. Jackson
gastrointestinal tract to appear mildly obese. Pain in the left lower
quadrant of the gastrointestinal tract again shows signs and the presence
of the inflammation. Moreover, it is the small intestine from where the
nutrients are absorbed in the blood stream. High level of inflammation

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PATIENT CASE STUDY
followed by formation of the granuloma in the small intestine prevents
this normal absorption of the nutrients and thus further generating the
pain. Furthermore, this inflammation in the gastro-intestinal tract leads to
the generation of the delayed type hypersensitivity response or other type
I and Type II hypersensitivity response. This rise in the hypersensitivity
response leads to the increase in the levels of the cytokines mostly IL-8.
High levels of IL-8 in the blood caused problem with the urinalysis
(Steenholdt et al., 2012).
Headache in the last few days as encountered by Mr. Jackson
may not have a direct relation with the pathophysiology of the Crohn’s
disease however, increase in the level of abdominal pain, lack of nutrient
and lack of sleep might be the reason behind this sudden headache.
Thus from the above detailed analysis of the condition of Mr.Jackson on
the basis of disease aetiology and pathophysiology, it seems that Mr.
Jackson might be suffering from Crohn’s disease.

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PATIENT CASE STUDY
Part 2
Inflammatory Bowel Disease is an umbrella disease under which
falls Crohn’s disease and Ulcerative Colitis.
The symptoms of crohn’s disease and Ulcerative Colitis are more or
similar.
The common symptoms of the Crohn’s disease and Ulcerative Colitis
are:
 Crampy abdominal pain
 Watery excretion of stool or diarrhea
 Malasie
 Nausea
 Fatigue
 Urgent bowel
So taking the medical condition and the symptoms Mr. Jackson into
consideration, he becomes a bit dubious to claim that he is suffering from
Crohn’s disease. He might also be the victim of the Ulcerative Colitis.
Ulcerative colitis affects colon and the rectum leading to chronic
inflammation. Thus, Ulcerative colitis affects mostly the lower portion of
the gastrointestinal whereas; Corhn’s disease can affect or may cause
inflammation to any portion of the gastrointestinal tract (Bressler et al.,
2015).
Confirmatory test 1: Ultrasonography
In order to detect the exact Inflammatory Bowel disease that has
affected Mr. Jackson, a ultrasonography of the entire stomach is
mandatory. The ultrasonography will reveal the exact point of
inflammation via show casing the organo-megally. It is in the ileum or in
the upper portion of the respiratory tract then it will be Crohn’s disease
while if the organ enlargement is seen in the rectum or colon then
Ulcerative Colitis can be confirmed (Chatu, Subramanian & Pollok, 2012).

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PATIENT CASE STUDY
Confirmatory test 2: Bacterial culture of the Stool
Crohn’s disease as discussed is caused by Mycobacterium avium
paratuberculosis whereas Ulcerative Colitis is mostly caused by
Escherichia coli (Winter et al., 2013). A bacterial culture test using the
selective media for the Escherichia coli and Mycobacterium avium
paratuberculosis will help in the elucidation of the exact micro-organism
colonizing in the gastrointestinal tract leading to the elucidation of the
disease.

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References
Ananthakrishnan, A. N., Higuchi, L. M., Huang, E. S., Khalili, H., Richter, J.
M., Fuchs, C. S., & Chan, A. T. (2012). Aspirin, nonsteroidal anti-
inflammatory drug use, and risk for Crohn disease and ulcerative
colitisa cohort study. Annals of internal medicine, 156(5), 350-359.
Baumgart, D. C., & Sandborn, W. J. (2012). Crohn's disease. The
Lancet, 380(9853), 1590-1605.
Bressler, B., Marshall, J. K., Bernstein, C. N., Bitton, A., Jones, J., Leontiadis,
G. I., ... & Group, T. U. C. C. (2015). Clinical practice guidelines for
the medical management of nonhospitalized ulcerative colitis: the
Toronto consensus. Gastroenterology, 148(5), 1035-1058.
Chatu, S., Subramanian, V., & Pollok, R. C. G. (2012). Meta‐analysis:
diagnostic medical radiation exposure in inflammatory bowel
disease. Alimentary pharmacology & therapeutics, 35(5), 529-539.
Kyle, J. (2013). Crohn's disease. Butterworth-Heinemann.
Manninen, P., Karvonen, A. L., Huhtala, H., Rasmussen, M., Salo, M.,
Mustaniemi, L., ... & Collin, P. (2012). Mortality in ulcerative colitis
and Crohn's disease. A population-based study in Finland. Journal of
Crohn's and Colitis, 6(5), 524-528.
Steenholdt, C., Svenson, M., Bendtzen, K., Thomsen, O. Ø., Brynskov, J., &
Ainsworth, M. A. (2012). Acute and delayed hypersensitivity
reactions to infliximab and adalimumab in a patient with Crohn's
disease. Journal of Crohn's and Colitis, 6(1), 108-111.
Travería, G. E., Zumarraga, M., Etchechoury, I., Romano, M. I., Cataldi, A.,
Alvarado Pinedo, M. F., ... & Romero, J. R. (2013). First identification
of Mycobacterium avium paratuberculosis sheep strain in
Argentina. Brazilian Journal of Microbiology, 44(3), 897-899.

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Winter, S. E., Winter, M. G., Xavier, M. N., Thiennimitr, P., Poon, V.,
Keestra, A. M., ... & Popova, I. E. (2013). Host-derived nitrate boosts
growth of E. coli in the inflamed gut. science, 339(6120), 708-711.