Jordan has been admitted to hospital with a five day history of right lower abdominal cramping pain, a feeling of abdominal bloating, nausea and vomiting, and an increased amount of abdominal gurgling and rumbling.
Jordan James is a 25-year-old male. Jordan has been admitted to hospital with a five day history of
right lower abdominal cramping pain, a feeling of abdominal bloating, nausea and vomiting, and an
increased amount of abdominal gurgling and rumbling. Jordan stated that over recent weeks, he has
experienced persistent diarrhoea, lower right abdominal pain and tenderness, fatigue and malaise.
Jordan stated he has not been able to keep up with his work demands and is not getting quality rest
and sleep. Due to his diarrhoea and current vomiting Jordan states that he has been reluctant to eat
or drink much during the past five (5) days. He reported that he has lost seven kilograms in the last
Jordan was diagnosed with Crohn’s disease when he was 17 years old. His Crohn’s disease was
diagnosed after Jordan presented to his general practitioner (GP) with a perianal abscess. Since his
diagnosis and surgical management of his perianal abscess, Jordan’s Crohn’s disease has been
managed with pharmacological (infliximab) and dietary strategies, and medical monitoring. During
this time, Jordan has had a number of exacerbations of Crohn’s disease.
Jordan’s observations on admission were
• Blood pressure: 92/52 mm/Hg
• Pulse rate: 112 beats/minute
• Weak peripheral pulses
• Respiratory rate: 24 breaths/minute
• Temperature: 38.3C
• Sa02: 97% in room air
• Weight: 75 kilograms
• Height: 188 cm
o specific gravity: 1035
o dark coloured urine
o no other abnormalities noted
On examination, Jordan had a distended abdomen, a tender mass in his right lower abdominal
quadrant and audible bowel sounds. His skin was pale and dry with poor turgor. His extremities were
cool to touch. The medical officer (MO) noted that Jordan had poor capillary refill and flat neck veins.
The MO ordered some preliminary blood tests and an abdominal CT scan.
Initial pathology results
• Haemoglobin: 7.9mmol/L (8.1 – 11.2mmol/L)
• Haematocrit: 51% (35 – 47%)
• WBC: 13.9 X 109/L (4.3 – 10.8 X 109/L)
• Erythrocyte sedimentation rate (ESR): 26.5mm/hour (0 – 13 mm/hour)
• C-reactive protein (CRP): 30.7mg/dl (20 mg/dl)
• Albumin: 30.5g/L (35 – 50 g/L)
401207 – Health Variations 1 Perioperative
Learning Guide – Autumn 2018
The MO returns to discuss the results of the CT scan with Jordan. Jordan has developed a
stricture causing a bowel obstruction in his terminal ileum. Jordan is referred to a
gastroenterological surgeon. The surgeon explains to Jordan that he will require a surgical
resection of the affected ileum and an end-to-end anastomosis of the ends of the ileum. The
surgeon also tells Jordan that he has numerous large patches of inflamed mucosa and
submucosa throughout his small bowel and colon.
The MO orders the following
• pethidine 75mg IMI QID PRN
• metoclopramide (Maxolon) 10mg IMI TDS
• 1000mL Hartman’s solution over 6 hours via IVI
• methylprednisolone 20mg IVI TDS
• nil by mouth
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