[24F] With severe abdominal and back pain, history of Crohn's disease

Patient Description

A 24-year-old female with a history of Crohn’s disease, celiac disease, acute liver injury, and endometriosis presents with severe abdominal pain for the past week, with today being the worst. The pain is described as sharp and cramping, located in the lower left quadrant, and rated 10 out of 10 in severity. The patient also reports extreme pulsating lower back pain that started suddenly today and worsens when standing. Additionally, she has been experiencing watery and loose diarrhea 5-10 times a day, with blood in the stool, and a fever of 101°F for the past two days, on and off. The patient visited the ER two days ago due to inflammation in the distal ileum and was prescribed prednisone 50mg daily. She has not noticed any side effects or changes in her symptoms since starting prednisone. Her current medications include Rinvoq 30mg, prednisone 50mg, Valtrex 1g daily, and Norco 5mg every 6-8 hours. She also takes Benadryl and Tylenol as needed. The patient has allergies to morphine, hydroxyzine, and iodine contrast.

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Arora's Assessment

What might be happening

Based on the information you’ve provided, there are several serious conditions that could be causing your symptoms:

  1. Crohn's Disease Flare-Up: Given your history of Crohn's disease, a flare-up could be causing your severe abdominal pain, diarrhea, and blood in your stool. Crohn's disease can lead to inflammation in different parts of the digestive tract, which can cause these symptoms. Treatment typically involves medications to reduce inflammation and manage symptoms.

  2. Intestinal Obstruction: The sudden onset of severe abdominal pain and cramping could indicate an intestinal obstruction, which is a blockage that prevents food or liquid from passing through your intestines. This is a medical emergency and often requires immediate treatment, which may include surgery.

  3. Infection or Abscess: The presence of fever suggests that there might be an infection or abscess in your abdomen. Infections can be serious and may require antibiotics or surgical intervention.

  4. Perforation: A perforation (hole) in the intestine can cause severe pain, fever, and other symptoms. This is a life-threatening condition that requires emergency medical treatment.

What you can do

Given the severity of your symptoms and your medical history, it is crucial that you seek immediate medical attention. Here are some steps you can take:

  1. Go to the Emergency Room: Given the severity of your pain, fever, and other symptoms, you should go to the emergency room immediately. If possible, have someone drive you or call an ambulance.

  2. Call 911: If you are alone, feel light-headed, or your symptoms worsen, call 911 for emergency medical assistance.

  3. Bring Your Medical Information: When you go to the hospital, bring a list of your current medications, your medical history, and any recent test results or discharge papers from your recent ER visit.

  4. Stay Hydrated: While waiting for medical help, try to stay hydrated, especially since you are experiencing diarrhea. However, avoid eating or drinking too much, as this could worsen your symptoms.

Remember, I am not a doctor, and it is essential to seek care from real health professionals to receive a formal diagnosis and appropriate treatment. Your health and safety are the top priority.

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3 mo ago

People Also Ask

What are the common symptoms of a Crohn's disease flare-up?

Common symptoms of a Crohn's disease flare-up include severe abdominal pain, diarrhea, blood in the stool, fatigue, and weight loss. These symptoms occur due to inflammation in the digestive tract.

How can an intestinal obstruction be identified and treated?

An intestinal obstruction can be identified by symptoms such as severe abdominal pain, cramping, vomiting, inability to pass gas or stool, and abdominal swelling. Treatment often requires hospitalization and may include medications, nasogastric tube insertion, or surgery to remove the blockage.

What are the signs of an abdominal infection or abscess?

Signs of an abdominal infection or abscess include fever, severe abdominal pain, tenderness, swelling, and sometimes nausea or vomiting. Diagnosis typically involves imaging tests, and treatment may require antibiotics or surgical drainage.

What should I do if I suspect a perforation in my intestine?

If you suspect a perforation in your intestine, seek emergency medical attention immediately. Symptoms include sudden severe abdominal pain, fever, nausea, and vomiting. This condition is life-threatening and requires urgent surgical intervention.

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