Meet Jennifer
30 Year Old Female
- Complaint
- Medication
- Family
- Social
- Physical
- CC: abdominal pain, diarrhea, fecal urgency
- No weight loss
- Hypothyroidism
- Iron-deficiency anemia
- Dysthymia post-partum
- Oral aphthous ulcers
Learning Objectives
Recognize when patient referral to a gastroenterologist from primary care is appropriate and timely
Describe safety and efficacy of current and emerging medications for ulcerative colitis and Crohn’s disease
Describe strategies for modifying treatment regimens for symptom relief and to achieve remission
Begin the case study sequence
1
Diagnosis – Primary Care
Jennifer has a BMI of 26 and says she has been heavier than she would like since her pregnancy. She mentions that she was diagnosed with mild anemia postpartum, and that her obstetrician prescribed FeSO4 (525mg daily). She is afebrile, and her physical exam is unremarkable except for a slight abdominal tenderness that does not localize to any quadrant and has no associated rebound or guarding.
2
Medication Management - Gastroenterology
You examine Jennifer after she is referred to you by her primary-care physician. After reviewing her history and labs, you order an MRI and find mild thickening of the last 15 centimeters of her terminal ileum. These imaging findings lead Jennifer to worry that she has colon cancer. You assure her that the findings could be due to a number of causes and that a colonoscopy will provide the opportunity to obtain tissue samples of the affected area to make a diagnosis.
3
Health Maintenance – Primary Care
About a year after her initial Crohn’s diagnosis, Jennifer returns to you, her primary care physician, for a regular health maintenance visit. Her gastroenterologist recently started her on biologic therapy for her Crohn’s Disease. She feels relatively well on the new therapy and mentions that she and her husband are starting to think about having another baby.
