1.Justify hypothesis by Aetiology and Pathophysiology relevant to Mr Jackson’s Presentation.
2.Name one other chronic disease that explains Mr Jackson’s symptoms. Justify what further data, such as diagnostic tests and/or further history, which would enable a clinician to discriminate between these two diseases.
Patient Case Study
- Name of the Patient: Mr. Bob Jackson
- Age: 55 years
- Sex: Male
- Symptoms: Diarrhea, Nausea and Malaise
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) 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 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
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
- 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).
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.
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.
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.