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ULCERATIVE COLITIS. Presentation :Dr.Doaa AL-Masri. Attendance :Dr.Yousef Abu-Osbaa. Discussion :Dr.Hisham Al-Nazer. History . Mohammad is 5 years old male patient, who was referred from the West Bank as a case of ulcerative colitis for further evaluation. . History.

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ulcerative colitis

ULCERATIVE COLITIS

Presentation :Dr.Doaa AL-Masri.

Attendance :Dr.Yousef Abu-Osbaa.

Discussion :Dr.Hisham Al-Nazer.

history
History
  • Mohammad is 5 years old male patient, who was referred from the West Bank as a case of ulcerative colitis for further evaluation.
history3
History
  • At 4 months of age, he had large amount of watery diarrhea 4-6 times/day mixed with mucous and blood, with occasional vomiting.
  • He was managed as cow’s milk protein allergy without improvement for the next 5 months.
history4
History
  • At 9 months of age, ulcerative colitis was diagnosed by colonoscopy.
  • Treated with Prednisone, Sulfasalazine and Multivitamins, with no improvement.
  • Diarrhea continued with exacerbation by infections, associated with poor weight gain and loss of appetite.
  • He was referred to Jordan Hospital for further evaluation.
history5
History
  • Vaccination up to age.
  • Nutritional history:
  • Breast fed till the age of 2 years.
  • Semisolid food was introduced at the age of 6 months .
  • Now he eats regular food but with poor appetite.
history6
History
  • Development history: appropriate for age.
  • Family history : unremarkable.
  • Social history: unremarkable.
physical examination
Physical examination
  • The patient looked ill, pale,wasted, not jaundiced.
  • Normal vital signs.
  • Weight : 12.5 kg ( 3 standard deviation below the mean) .
  • Length : 92cm ( 4 standard deviation below the mean).
physical examination8
Physical examination
  • Head & Neck : No oral ulcers.
  • Chest: Good air entry bilaterally. No added sounds.
  • Heart: Normal S1, S2. No murmur .
  • Abdomen : soft, and lax. No tenderness. No palpable organs.
  • Normal male genitalia.
  • Anal orifice : normal.
  • CNS: Grossly intact.
  • Lower limbs: Muscle wasting.
investigations
Investigations
  • Hb. : 9.4 gm/dl
  • PCV : 30.4 gm/dl.
  • MCV: 61fl- MCH : 19 pg –MCHC:30.9 g/dl
  • WBC: 23.9/L:
  • - Neutrophil : 40%.- Lymphocyte:44%
  • -Monocyte : 4%. - Eosinophil : 2%.
  • Blood film : Neutrophils showed left shift
investigations10
Investigations
  • Liver function test :normal.
  • Kidney function test: normal.
  • Urinanalysis and culture: negative.
  • ESR : 90 mm/1st hour.
  • CRP : 48mg/l. (Normal <6 mg/dl ).
  • Wrist X-ray: delayed bone age ( 2.5 y).
investigations11
Investigations
  • Stool Rotazyme: negative. Culture : no growth, occult blood: positive , colour : green, appearance : soft, WBC ; 42/HPF, RBC : 55/HPF , E. histolytica cyst and trophozoite.
  • Stool analysis was repeated after 7 days of Metronidazole and it was negative for ova and cyst but many budding yeast were seen.
course in hospital
Course in hospital

The patient was started on:

  • Metronidazole.
  • Mesalazine .
  • Prednisone .
  • Azathioprine.
course in hospital14
Course in hospital
  • The patient developed severe diarrhea with poor oral intake and severe dehydration, hyponatremia and hypokalemia resulted and so I.V fluids were started for rehydration.

-Oral thrush and budding yeast in stool so, Nystatin and Mycoheal was given.

medication on discharge
Medication on Discharge

Azathioprine 12.5 mg P.O Q 12 hr.

Prednisone 5 mg tab Q 6 hrs.

Mesalazine 250mg Q12hr.