Symptoms, Symptoms And Treatment Of A Family History Of Inflammatory Bowel Diseases ( Ibd ) Or Autoimmunities

Physical Examination: General: The patient is an alert, oriented male appearing his stated age. He appears to be in moderate distress. Vital signs: blood pressure 132/78 and pulse 68 and regular. Temperature is 38.56 oC (101.4 oF). HEENT:Normocephalic, atraumatic. Pupils were equal, round, and reactive to light. Ears are clear. Throat is normal. Neck: The neck is supple with no carotid bruits. Lungs: The lungs are clear to auscultation and percussion. Heart: Regular rate and rhythm. Abdomen:Bowel sounds are normal. There is rebound tenderness with maximal discomfort on palpation in the right lower quadrant. Extremities: No clubbing, cyanosis, or edema.

PAST MEDICAL/SURGICAL HISTORY: As above. SOCIAL HISTORY: Status post heavy smoking, 50+-pack-year history. He quit 10 years ago. Status post alcohol abuse, quit 3 or 4 years ago. He lives by himself and no longer drives but has 2 daughters here in Miami who take him where he needs to go. FAMILY HISTORY: Patient’s wife died 14 years ago of COPD due to lifelong smoking. Brother has diabetes mellitus. Unremarkable family history otherwise. REVIEW OF SYSTEMS: No fever, no nausea, no vomiting. Patient has incontinence of bowel. No shortness of breath, no chest pain, no palpitations. PHYSICAL EXAMINATION: Well-developed, well-nourished white male who is alert and oriented x3. Wears bilateral hearing aids. Afebrile with blood pressure 130/70. NECK: No carotid bruits. LUNGS: Clear to auscultation bilaterally. HEART: S1, S2 normal. No murmur. No S3 or S4. ABDOMEN: Soft, nontender. No arterial bruits. No masses, no organomegaly. EXTREMITIES: No edema. No pulses present in the lower extremities. The right great toe is absent. The left great toe shows a 2 x 1 cm deep ulcer with redness around the toe with pus extruding. PLAN 1. Get consult with Dr. Beth Brian, Infectious Disease. 2. Follow up with Dr. Hirsch, Orthopedics. (Continued)

PHYSICAL EXAMINATION: HEENT: Tympanic membranes and external auditory canals are within normal limits. Throat is clear with no gingival lesions. He is ______________. No obvious proliferate retinopoathy. NECK: No carotid bruit. No thyroid enlargement. LUNGS: Clear to auscultation. HEART: No S3, S4 or murmurs. ABDOMEN: Soft with no organomegaly. Normal bowel sounds. FEET: Good dorsalis and posterior tibial pulses bilaterally. Left foot has no abrasions, lesions, sores or ulcers. Right foot shows obvious deformity from previous break. He has an area located between his second and third metatarsal head that has clearly been an abscess that has broken through. He also has an obvious foot ulcer located over the instep of his right foot, full thickness. There is tracking to the broken foot, to which the ulcer area is connected and there is a question of osteomyelitis in this area.

Review of the medical record indicates that he had a MVA in 1977 with C4-5 injury that resulted in him been a Quadriplegic. Due to his bedbound and immobility status he has had multiple pressure ulcers over the years that have resulted in hospital admission and rehab stays. Other medical history include, HTN, hyperlipidemia, Sacral pressure ulcer, Right hip pressure ulcer, Constipation, depression. Bilateral arm contractures, bladder cancer, prostate cancer, urostomy and colostomy, aspiration pneumonia, neuropathy and MRSA.

He was diagnosed with liver disease a few years ago. He had a history of positive hepatitis C virus antibody. His hepatitis C virus PCR was checked on two different occasions and has been negative. He was evaluated by hepatology, Christopher Albers, MD at Tampa General Hospital for his liver disease. He had a liver biopsy done showing evidence of liver cirrhosis. Per patient's report, he was told that he is not a candidate for a liver transplant at his point. No evidence of abnormal liver function tests in the records and his coagulations were in normal range. He has chronic thrombocytopenia that has been attributed to alcohol use and liver disease. No history of hematemesis. He reports that he had endoscopy as part of the work up at Tampa General Hospital but he does not recall the results. His last colonoscopy was done this year at Tampa General Hospital. No reported malignancy, per patient's report. He also has imaging for his abdomen and pelvis but we do not have the results at this time.

Chweyah, dated 08/11/2017, indicated that the claimant presented for a follow-up visit after his discharge from the hospital on 08/08/2017. He was admitted on 08/04/2017 due to normocytic anemia, pain in both knees, starvation ketoacidosis, hypertension, gout with tophus, and duodenitis. The esophagogastroduodenoscopy revealed erythematous duodenopathy, erythematous mucosa in the antrum, and small hiatal hernia. He had a colonoscopy which revealed internal hemorrhoids. Objective findings showed blood pressure of 112/86 with a pulse of 105. He was diagnosed with quadriceps weakness, pain in both knees, normocytic anemia, type 2 diabetes mellitus, hypertension, stable chronic kidney disease stage III, and bilateral impacted cerumen. It was noted that he can return to work on 08/16/2017 with limitations of not standing for more than 10 minutes at a time for 1

Mr. Lewis is seen for Dr. Craane at Oak Park Heights. Mr. Lewis is a 74-year-old gentleman with multiple medical problems, including rheumatoid arthritis, hepatitis C, diabetes mellitus, hypertension, and severe respiratory insufficiency. His recent history is well known to us as he was originally at Faribault when he became ill with the current episode of leg ulcerations. He was being treated for rheumatoid arthritis and severe COPD at that time and had significant edema in his legs. He was being treated with methotrexate for his rheumatoid arthritis and was also on low dose prednisone at that time. He developed very, very painful leg lesions that quickly developed from darkened skin lesions to undermined ulcerations that had a gangrenous

At today's visit he is awake, alert and oriented. He complains of generalized pain. He states “I have pain all over today, my head, my back, my feet" I have not felt good for the last few days”. He rates his pain as 6/10 in severity; he describes his pain as shooting pain in different places. His pain does

Crohn’s disease is a chronic inflammatory bowel disease that is characterized by inflammation of the digestive, or gastrointestinal tract. It can affect any part of the GI tract, including the mouth and anus. However, Crohn’s most often affects the end of the small intestine (Crohn’s & Colitis, 2016). Crohn’s disease does not have a cure and there is no exact cause for the occurring disease. “Since the exact cause of Crohn’s disease is unknown, it has been linked to a combination of environmental factors, immune function and bacterial factors, as well as a patient’s genetic susceptibility to developing the disease” (History Cooperative, 2014).

Clay-colored stool indicates the absence of bile in the stool, which may be seen in clients with cirrhosis or cholecystitis.

CBC showed leukocytosis with a left shift, hyperglycemia, uremia, high ALT and ALP, hypercholesterolemia and lipemia.

Crohn's disease is an autoimmune disease where the immune cells in the Gastrointestinal tract become senstive to certain bacterias causing inflamation, abdominal pain, and unusual bowel movements. When in individual has crohns disease it also means that their immune system attacks their healthy cells. Based on Amelia from the case study, she had to change her diet and go on antibiotics which caused her to have blotchy skin and swollen legs. Many who experiences this disease and go on medication experience a lot of sickness and pain, especially because their body is more susceptible to bacteria and diseases due to their weakened immune

Alleged disability: Irritable bowel syndrome (IBS), ulcerative colitis, chronic pain and fatigue, anemia, anxiety, depression, and insomnia. Additionally, she had an ulcer and blood loss. She reported that the chronic pain worsened the depression and fatigue and she was unable to finish her daily activities.

Inflammatory bowel disease (IBD) can be defined as the chronic condition (it is persistent/ long-standing disease) resulting from inappropriate mucosal immune activation. Inflammatory bowel disease (IBD) can start at any age. However, it is frequently seen among teenagers And also among young adults in their early twenties, both genders can be affected by this disease. There are two conditions that traditionally comprise inflammatory bowel disease (IBD): Ulcerative colitis and crohns disease. Comparison between Ulcerative colitis and crohns disease are clinically useful, because distinguishing between the two conditions allow specialists to choose the right management way. Comparison between Ulcerative colitis and crohns disease are

Patient with complaints of edema into both of his lower legs and ankles. States this came about two days ago. Prior to that 2-3 days before that he states he had a little bit of flank pain on his left side. States he drank a lot a water that day and then it resolved and has not had it since, so here he is today. As far as medications, he is on no medications.