Only microbiology part (tests , results,discussion)
Case - 46 year old Ashley Aulson works an executive officer and is married and a mother of four. She takes care of her family and goes to work and therefore has a busy life style where she has a high intake of junk food due to her busy schedules. She was also undergoing stress because she could not spend enough time with her family. Ashley was under oral contraceptive pills and isotretinoin for 03 months to cure her severe cystic acne. She experienced being tired all the time and she also had cramp pains in the lower abdomen for 02 weeks . She has regular menstruations and did not have heavy bleeding. Self-medication was done to herself where she took pain killers to subside her pain.
However, her pain subsided for few days but worsened later and she had her first admission to the hospital complaining of loss of appetite along with lower abdominal pain. Blood samples were taken and sent to the haematology and biochemistry lab to obtain a FBC,ESR and CRP. She was advised to get an ultrasound scan of her abdomen. Her FBC indicated low levels of WBCs, RBCs and platelets and her CRP levels were elevated and ESR levels we seen to be normal.
She was advised to get her liver function tests (LFTs), kidney function tests and random blood sugar and a lipid profile test. It was found that the kidney function tests and random blood sugar was normal. But her liver function tests showed abnormal levels of AST and AST. Her lipid profile showed elevated levels of triglycerides and low levels of high-density lipoprotein. By examining her elevated CRP levels, ultrasound scan, her abnormal AST and ALT levels and her lipid profile, it was found out that she was suffering from non-alcoholic fatty liver disease. Her physician asked her to reduce the intake of junk food and to engage in more physical activities and to return back in two months.
Additionally, it was also found that the patient had a family history of colon cancer, hypertension and arthritis. Her grandmother was diagnosed with colon cancer two months prior to her death at the age of 60.
On her next visit, she complained of having fever,increased pulse rate, diarrhoea (stool mixed with blood), severe cramp discomfort, pain in her joints and reddish eyes. Blood was taken and sent to the haematology, biochemistry and immunology departments for of FBC, ESR and CRP respectively. Her RBCs and MCV was reduced, CRP and ESR levels were increased indicating that she had anaemia and presence of inflammation.For further clarification between ulcerative colitis and Crohn'sdisease , detection of auto-antibody pANCA testing was done which showed the presence of pANCA in her blood.She was admitted to the hospital to undergo a colonoscopy followed by a biopsy. Her colonoscopy indicated irritated swollen tissues in the lining of the large intestine, ulcers mainly in areas of the sigmoid colon, abnormal growth of polyps and was friable (bleeds on touching).Her biopsy test showed the absence of any appearance of non-peri intestinal crypt granulomas, glandular distortion and goblet cell depletion which ultimately confirmed that she was suffering from ulcerative colitis.
It was found that the patient was suffering from severe ulcerative colitis because all of her symptoms were complicated if compared to mild and moderate ulcerative colitis. The patient was then subjected to few medications. She was subjected to intravenous hydration (which was composed of 1L of 0.9% saline + 2L dextrose -saline /24hr + 20 mmolK+/L for maintenance). Her pulse and blood pressure was frequently monitored and her stool frequency was monitored . Her bowel sounds and the tenderness was also examined and daily FBC,ESR and CRP counts were monitored to check if the patient was recovering. She was also prescribed 50 mg of hydrocortisone in 100ml of 0.9% saline. She was under special attention for 3 days and if her CRP levels increased more than 45 and her bowel opens more than 8 times per day, after 3 days , the doctors decided to consider of performing a colectomy. At the same time if she improved in five days, she was to be subjected to 40mg / 24hr of prednisolone along with 500 mg/6hr of sulfasalazine in order to maintain remission.