What is the workup and management for a patient presenting with duodenitis and jejunitis, accompanied by leucocytosis and bright red blood per rectum?

From the Guidelines

The management of duodenitis and jejunitis with leucocytosis and bright red blood per rectum requires prompt evaluation and treatment, with an initial workup including a complete blood count, comprehensive metabolic panel, coagulation studies, and blood cultures, as well as endoscopic evaluation with upper endoscopy and colonoscopy, and imaging studies such as CT enterography or MR enterography to assess the extent of small bowel involvement 1.

The patient's presentation with leucocytosis and bright red blood per rectum suggests a possible infectious or inflammatory cause, and empiric antibiotic therapy should be initiated with a broad-spectrum regimen such as piperacillin-tazobactam 4.5g IV every 6 hours or ciprofloxacin 400mg IV every 12 hours plus metronidazole 500mg IV every 8 hours for 7-14 days, depending on clinical response 1.

Some key points to consider in the management of this patient include:

• The use of abdominal CT imaging to diagnose acute left-sided colonic diverticulitis, with a high sensitivity and specificity for this condition 1
• The potential for misdiagnosis of diverticulitis as other conditions, such as inflammatory bowel disease or cancer, and the importance of considering these alternative diagnoses in the workup 1
• The role of proton pump inhibitors, such as pantoprazole 40mg IV twice daily, in reducing gastric acid production and managing symptoms 1
• The importance of bowel rest and nutritional support in severe cases, and the potential need for corticosteroids, such as prednisone 40-60mg daily, in patients with inflammatory bowel disease 1

Overall, the management of duodenitis and jejunitis with leucocytosis and bright red blood per rectum requires a comprehensive approach that addresses both the acute bleeding and underlying inflammation, while also considering the potential for alternative diagnoses and the need for targeted therapy.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Workup for Duodenitis and Jejunitis

• The workup for duodenitis and jejunitis presenting with leucocytosis and bright red blood per rectum should include a thorough medical history, physical examination, and laboratory tests to determine the underlying cause of the symptoms 2, 3.
• Laboratory tests may include complete blood count (CBC), blood chemistry tests, and stool tests to check for blood or infection 4, 5.
• Endoscopy or capsule endoscopy may be performed to visualize the duodenum and jejunum and check for any mucosal injury or bleeding 2, 6.

Management of Duodenitis and Jejunitis

• The management of duodenitis and jejunitis depends on the underlying cause, but may include the use of proton pump inhibitors (PPIs) to reduce stomach acid and prevent further mucosal injury 3, 5.
• If nonsteroidal anti-inflammatory drugs (NSAIDs) are suspected to be the cause, they should be discontinued or replaced with a COX-2 selective NSAID or a non-NSAID analgesic 3, 5.
• Antibiotics may be prescribed if an infection is suspected, and blood transfusions may be necessary if there is significant blood loss 4, 6.
• In some cases, surgery may be necessary to repair any damage to the duodenum or jejunum 2, 3.

Prevention of NSAID-Induced Gastrointestinal Injury

• The use of PPIs or other gastroprotective agents can help prevent NSAID-induced gastrointestinal injury 3, 6.
• The use of COX-2 selective NSAIDs or non-NSAID analgesics can also reduce the risk of gastrointestinal injury 3, 5.
• Patients taking NSAIDs should be monitored regularly for signs of gastrointestinal injury, and should report any symptoms such as abdominal pain, bleeding, or black stools to their doctor immediately 2, 4.