Week 3

1. Top 3 differential diagnoses:

Due to the history of Crohn's disease, the presumptive final diagnosis for this patient is ICD K50.9 Crohn's disease, unspecified. Additionally, I would consider ICD K52.9 noninfective gastroenteritis and colitis, unspecified secondary to the patient's smoking and nicotine dependence, and ICD A08.4 viral intestinal infection.

2. Beneficial physical exam findings:

The precise site of the stomach discomfort and the features of the abdominal distress are useful dedicated physical investigation results. Discomfort in the upper right quadrant may indicate liver, gallbladder, lung, or pancreas pathology; pressure in the upper left quadrant may indicate splenic disease, and epigastric discomfort may indicate a pancreatic cause. Is the discomfort continuous or periodic, acute, mild, sore, cramping, or thumping, when does the pain occur, does anything trigger, ease, or aggravate the discomfort, and if so, how well did the drugs work? It was useful to be aware of similar features and questions. The existence of residual pain, Rovsing's sign, Murphy's sign, Psoas sign, organ swelling or nodularity on examination, and the existence, lack, or intensity of bowel noises are all physical exam observations that would be important to discover. These data will enable the clinician to check out the numerous probable abdominal alternative diagnoses. Lower right quadrant or periumbilical distress, nocturnal or chronic diarrhea frequently with mucus, blood, serious urgency, fever, fatigue, weight loss, decreased appetite, vomiting, nausea, night sweats, and amenorrhea are all commonly occurring assessment observations in Crohn's disease, which is my concluding diagnosis for this individual. Several of the clinical exam results were not included in the research study, although the individual did have stomach cramps, fever, diarrhea, and a decreased appetite. Chronic cigarette smoking, which is a major risk factor for Crohn's disease, is also a habit of the patient (Feuerstein et al.,2017).

3. Diagnostic tests:

Diagnostic procedures are not needed in this case because the individual has previously been diagnosed with Crohn's disease and is experiencing an exacerbation of her Crohn's. For a novel diagnosis, the clinician should look for 28 days or more of intestinal discomfort, weight loss, diarrhea, and evidence of inflammation like high-sensitivity C-reactive protein, an increased serum red blood cell sedimentation rate, or fecal calprotectin. In addition to this appearance, endoscopy with a histological investigation is required before a Crohn's diagnosis may be established (Ranasinghe,2021).

4. Treatment plan”

An easing dose of oral steroids such as prednisone is suitable for the treatment of Crohn's disease exacerbations and is successful in minimizing symptoms and signs and triggering active disease remission. A steroid prescription along with nutrition advice and a close-up assessment of symptom improvement would be an effective therapy regimen. Dietary habits short in fat, insoluble fibers, sugar, and lactose, as well as avoiding coffee, carbonated beverages, spicy foods, alcohol, vegetable skins, dairy, nuts, and popcorn, are all good in reducing exacerbations. It is better for the gastrointestinal tract to increase water intake and eat numerous, short meals, which can considerably enhance the quality of life for those with Crohn's disease (Ranasinghe,2021).

References

Feuerstein JD, Cheifetz AS. Crohn Disease: Epidemiology, Diagnosis, and Management. Mayo Clin Proc. 2017 Jul;92(7):1088-1103. doi: 10.1016/j.mayocp.2017.04.010. Epub 2017 Jun 7. PMID: 28601423.

Ranasinghe IR, Hsu R. Crohn Disease. [Updated 2021 Jun 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK436021/