Reference no: EM133384732

Roger, a 55year-old male is evaluated for a 4-month history of frequent and urgent defecation with loose and bloody stool, mild abdominal cramping and fatigue. He has up to eight bowel movements a day and often wakes at night with symptoms. Prior to onset, he had one bowel movement a day with well-formed stool. He does not have fever, nausea or vomiting, but has lost 3kg (7lb). He has mild joint pain in his knees and ankles that also began 4 months ago, which is worse in the morning and resolves somewhat during the day. The patient is a former cigarette smoker but quit smoking 2 years ago. His medical history includes hypertension and his only medication is hydrochlorothiazide.

On physical examination, vital signs are normal. There is mild lower abdominal tenderness without rebound or guarding. There are no palpable abdominal masses. Examination of the rectum shows gross blood. Lab studies: Hgb 12.3 g/dL, Hct 32%, RBC 3.4 million, MCV 76 fL, MCHC 28 g/dL, RDW 17%. Fecal leukocytes are present, but stool analysis is negative for infection.

Colonoscopy shows continuous erythema, friability, and loss of vascular pattern from the rectum to the splenic flexure. The rest of the colon and terminal ileum is normal. Histology shows cryptitis, crypt abscesses and crypt architecture distortion.

1. What non-pharmacologic and pharmacologic interventions will you use for your treatment plan? How does each intervention treat the pathophysiology of the diagnosis(es)? What is the priority for each intervention (which interventions are first versus later)?

2. What are the important prescribing considerations for the pharmacologic interventions (medications are Infliximab and Sulfasalazine?

3. What outcomes would you anticipate - therapeutic effects and adverse effects of Infliximab and Sulfasalazine? How will you evaluate for these outcomes?

4. What patient education and follow up is required for the medications prescribed?