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INTRODUCTION

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CASE LEARNING OBJECTIVES

  • Recognize the signs and symptoms of ulcerative colitis (UC)

  • Identify the goals of therapy for patients with UC

  • Develop an appropriate treatment and monitoring plan for UC

  • Select appropriate drug therapy for a patient with active UC

  • Properly educate a patient regarding proper use and potential adverse effects associated with drug treatments for UC

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PATIENT PRESENTATION

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Chief Complaint

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"I'm still having abdominal pain and diarrhea when I lower my dose of prednisone."

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History of Present Illness

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Allison Gentry is a 29-year-old woman who presents to her gastroenterologist complaining of 2–4 bloody bowel movements per day, intermittent crampy abdominal pain, low-grade fever, and feeling fatigued. She was initially diagnosed with UC 15 months ago. At that time she was placed on Asacol 4.8 g/d, which initially induced remission of her UC. Five months ago she experienced a flare of her UC, for which she received a course of prednisone 60 mg daily. Since that time she has been unable to taper off the prednisone. Her typical UC symptoms, particularly sharp abdominal pain, bloody diarrhea, and low-grade fever reappear once her daily prednisone dose is lowered below 30 mg daily. She still takes her Asacol and reports adherence to this therapy. Over the last 2 months she has noticed an increase in fatigue as well. She feels like she wants to rest all the time and she is unable to jog as far as she used to when her symptoms were under better control. She has also had a 15 lb (6.8 kg) weight gain over the last 5 months and is experiencing intermittent outbreaks of acne, which she views as very embarrassing. She is frustrated with the fact that her UC was initially under control, but now seems to be less responsive to her Asacol. Since she has recently gotten engaged and is planning her wedding for next year, she would like to be tapered off the prednisone as soon as possible. Likewise, she and her fiancé have also discussed the desire to have children once they are married.

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Past Medical History

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UC (classified as pancolitis by colonoscopy 15 months ago)

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UTI (3 years ago)

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GERD

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Family History

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Father had colon cancer at the age of 54, and is still alive following resection and chemotherapy. Mother is alive at the age of 70 with hypothyroidism. She has two younger sisters, both healthy.

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Social History

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Engaged and lives with her fiancé. No children. Works as a physical therapist at a local hospital. Sexually active.

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Tobacco/Alcohol/Substance Use

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Occasional alcohol use; (+) tobacco use 1 ppd for 10 years, (−) illicit drug use.

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Allergies/Intolerances/Adverse Drug Events

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