Weekend case study 24092016 -IBD

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24 Sep 2016 - General

A middle aged lady, with background of long standing complex Crohns disease, had 2 prior surgical operation (Mid-jejunal resection few years ago due to obstruction and stricture, and terminal ileum resection 1 year ago, again due to bowel obstruction with the stricture), on infliximab every 8 weeks (for 1 year now) currently for her crohns disease. Patient was admitted through clinic due to increasing in bowel motion to around 6-8 times a day (mixture of loose stool to waterry stool, with intermitent blood), with abdominal cramp, nausea, reduced in oral intake, weight loss, for the lasty 2 months. She was well before that. Patient was treated with intravenous steorid, and prophylactic low molecular weight heparin (prevention of DVT/PE). A flexi-sigmoidoscopy was done, showed moderate patchy inflmmation with patchy ulcer, from anorectal region to mid-sigmoid (point of insertion of endosocpy).  What will be managment plan for her ???