Bethany nutton k n u t t o n 765306 21 year old lady observations temperature 37.5 heart rate 113 rate 15 blood pressure 121 over 73 sats 96% blood tests taken yesterday in the emergency department so investigations blood test taken yesterday the emergency department where she presented with generalized penis / pain and swollen feet she was discussed with an ed consultant at that time due to the constraints of the hospital and the fact that treatment won't be able to occur overnight to send patient home to return to amu in the morning wow so blood test phosphate normal full blood count hemoglobin 84 from a 123 with platelets 801 and neutrophils 11.22 with white cells of 13.7 microcytic anemia with mcv 78.3 and raised rdw at 16.3 aki stage 1 creatinine 65 up from 44 at a baseline sodium a 139 potassium 4.5 tsh normal bone profile normal but albumin 28 on lfts remainder of lfts biliary been less than 3 crp of 68 note has been chronically raised since april 2025 and has been as high as 227 in september 2025 urea 2.6 chest x-ray on the february 13 pre biologic screen was normal she also had a pre biologic screen has she she had in september 2025 a pre biologic screen which didn't demonstrate any blood borne viruses at that time and tb spot was negative thank you so reviewing the clinic letters known to doctor powells in gastroenterology new diagnosis of ulcerative colitis april 2025 2 admissions in june 2025 1 with a flare of erythema nodosum on a background of hydroadenitis suppurativa and the second admission was with a uc flare and was given some steroids but then switched to oral pentaza seen in clinic july 2025 with symptomatic improvement on pentaza and referrals made to rheumatology and dermatology at that stage crp increased from below 40 to 200 in the community leading to hot clinic appointment and received 2 short course of steroids since july due to be seen in rheumatology clinic soon family history of ibd including father who had a colectomy in 2025 and paternal uncle who has crohn's disease currently on pentaza 4 g granules and has had multiple courses of antibiotics for hidradenitis suppurativa seen the rheumatology team known to doctor winfield with fibromyalgia and ibd related arthritis on a with other medical problems iron deficiency and significant inflammatory response currently taking pentasa prednisolone 40 mg daily for 1 week then reduced by 5 mg every week to nothing calcium and vitamin d yeah was it ben yeah they just said she can't lie down she's got to have it in the day room is that okay she's good so plan was to start on infliximab how and when to pre biologic appointment to discuss however needing needed to have a chest x-ray prior to starting on infliximab and azathioprine hi chris it's grace in the waiting room waiting room 6 up to mccallum for us please yeah I'll try and find I'll try and get but we need to get you up to that I don't know if you're able to to live that afternoon yeah but it's nice to meet you you've been a lot can the gastroenterology this is mom yes ma'am hi you're poorly hey yeah how long have you been flaring for well just too scared to go sorry I'm not that scary am I just the whole process and I think that's why okay I saw you very quickly idea of it I think coming to terms with it as well you know she's so young of course think it's all just it's a lie but I think now it's hit your mental health you are so poorly you know so we gotta get you sorted haven't we you're poor pussy and how many times a day are you going for a poop I'm going normally which I don't understand mhmm it's it's mainly my body I do get pain sometimes like in the mornings and stuff but depends what you eat you know obviously but you cleaned your eating up haven't you you kind of yeah and smallened your portions and stuff so yeah it's not nest it's just like off and on her stomach like cleaning primarily yeah it's like this and her arthritis everything's just flaring and the arthritis is flaring up more than anything yeah yeah I can barely move but she was she'll be sick like 1 day she'll be sick a couple of times and then poo in diarrhea and blood and then be fine and then be fine the next day so it's just like that at the moment sporadic yeah and when the when the symptoms are bad how many times a day do you go like 8 mhmm with blood every time no no but with blood some of the times yeah mhmm yeah and that's blood on the pan in the in the on in the pan on the paper those on the paper on the paper and then in the toilet in the toilet sometimes I only pee for that and how often will that happen that happens when you and when did this all start back in june yeah that last year you were you were only a key for like a month and you were on a course of prednisolone for that month right and then after that she was fine for a couple of weeks and then and then it came with a decline and we wanted to get you on infliximab and azathioprine didn't you but she had a chest x-ray then they they were emailing us saying that they hadn't had it that she needs to go back in for another 1 and then obviously seeing your chest x-ray looks normal oh so we that that's all they needed to start the meds then should we just start it is that right can we get her on the meds I'm fed up with feeling like this I think you I think you I'm sorry I'm so so sorry look honestly you're gonna feel you won't even know how good you're gonna feel about these expenses and have a transfusion as well yeah good you're gonna feel a $100 there now an iron transfusion really bad yeah you look really sheer hemoglobin is 84 84 I know he's looked at you your crb is 68 hey and it's been and you've got a bit of a kidney injury with what's going on with how poorly you are your kidney function's been ah that's probably why you're feeling even more yeah because like sometimes I get like a it's not like a reinfection but you know when like it stings when you go to the toilet I get that like every now and then sometimes but it's only happened in the last few weeks have you had any fevers or something yes I I sweat in the at night you sweat yeah mhmm and then what's even if I'm cold I sweat at nighttime like if I'm and then this morning when you come down you're having a sweat weren't you like when going down the stairs overexerting it takes so much energy for me to move and what's your weight like she's fine so much for me she's lost her flu since since june I'm not gonna lie in in about a year oh in the past in the past year I've lost 5 stone I'm so sorry well just over a year now that's why we need to get you on these meds I'm literally there's nothing to me anymore and which joint's affected with your arthritis this is the legs knees my feet my ankles my hips my hands my wrists my shoulders elbows but she's got fibro as well so that's the mix of both of her isn't it that's it mm-mm pretty much everywhere pretty much get out of the mouth I know she's just a bit swollen her knees are on her feet are swollen it hurts like there yeah like there and she's got lumps as well like the the erythematous yeah on my legs and I get sweat squats all the time as well because I sweat so much and you got any marks down here on your sometimes she's got better eyes than she's now has it been in her doses so sick yeah you definitely have alright can I have a press of your legs to see if you've any fluid there your albumin's quite low isn't it cause you're quite inflamed yeah they said my crp level's way too high yeah don't if that's not the best yeah unfortunately when people have the crp doesn't really come from the: very much because the liver produces crp and your: is a separate part of your body so your liver doesn't really see it so think crp of 68 is bloody high in ulcerative colitis our a and e colleagues don't appreciate that because they're not specialists so they see your crp of 200 and they're like now we're talking yeah yeah but if it's coming from your: or crp very hard over 30 you're like oh that's pretty bad yes do you get that's the thing because of everything I've got it's just all attacking itself and then it comes together and then quite smooth yeah and you've had lots of steroids lately haven't you so no not recently not recently not recently was last year like from her cyst like her hydrodendocrine yeah she had a lot in the last couple of years but yeah last year steroids for since june no we gave you a course and then since then you haven't had any no I guess the 2 options are a I put you on some steroids now make you feel a bit better and then we get you up to allerton and give you the infliximab nasal papilla right or I have a chat with my boss how about the iron transfusions I wouldn't give you an iron infusion right now because you're too inflamed but after you've had the first dose of infliximab we could think about it bring your inflammation down a bit your inflammation because you're at risk of getting an infection at the so we're just if you give you loads of iron it's probably not the right thing we could we could once you've had a dose of steroids we we could but I think at the moment yeah the steroids will make you feel better well you know what's best just for you yeah I'll make you feel better that's fine the 2 options I give you steroids to keep you here and get you to allerton or I get you to allerton immediately and get the infliximab going today I'll have a chat to my boss yeah yeah we can do we'll do our best to you we just need to get you sorted now and I mean she's got white coat syndrome they are itchy she's got white coat syndrome so this is why she gets plenty of us staying in you know but we need to just get sorted now wish they kept me in last night because yeah she would have stayed in getting back he was I'm sorry crying 1 year ago I couldn't wake up but we just thought it's not why we do this stuff I don't yeah I've got rheumatoid arthritis and everything so it's just a constant being my carer isn't a think no it's hard for me of course because it's too much on me so we have to well no we keep a bunch of old ladies in hospital right on their fifth pneumonia of the week where we're not gonna do anything different yeah and then a a lady 2 year old lady who's very poorly who we could do something for we said no I'm sorry I'll speak to the ed too I feel like a nice thank you I am so glad that you were in actually you know what it turned out better because maybe then it's true I was on call yesterday as well oh was she on the the bedside bedside so can I have a listen to your chest that's good isn't it it's a bit better now when you get it somewhere alright better just sitting there not knowing what's in yeah vasquez on panethin sorry I don't mean to panic you're on no he's got white coat on he's nice he's the big best was he no that's lovely I think my heart's an is that right I think my heart's got an extra 2 she shouldn't put another 1 that's lovely well that's all we're gonna bit sore there it feels a bit swollen doesn't it actually yeah but then you've got fluid and stuff you've inflammation so your body yeah it feels there shall we x-ray your chest again and we'll x-ray your tummy at the same time make sure there's no complications associated with this before we start you off on a biologic treatment we'll get some more blood tests I'd suggest just to see what the trends in your markers of inflammation are yeah and we can kinda drip it so he can give you the afiximab at that time okay I'll chat to my boss and we'll try and get you up to allentown the only place in the hospital for your afiximab is allerton yep that's fine yeah yes yeah is that okay yeah that's fine in an ideal world we'll just get you straight up to and do it up there that's what I mean now now now we just get you up to allentown right and then get you on these meds so if it's alright if we got just get a couple of days in here hope you're absorbing alright because they're lovely on allerton think the nurse is so dark right I think so I think they're nice and fun yeah dad's a barren you didn't he daniel nuttman so we don't wanna head that way he's just doing that like his eyes smelled a poop he does will you just go nose blind I bet I'm doing that at home now because I'm like windows from the store I'll should I get you back around there yeah I'll take her I'll take her sure yeah probably probably better than mine oh I didn't know about that she was I think she was purposely trying to oh we haven't got a weight on are we no you're sorry I don't know are allergic to anything no good you don't think only that white tape yeah she just gets to be itchy yeah it's all itchy yeah you know why you're itchy did you give me a gum there think you're on pain yeah that that's what that that's what I mean she when it keeps me from a concussion sometimes when it goes very very hot it will get itchy can I go for a moment no I'll have to go for a moment stop you yeah so it's it's because stress winning by happening but it'll make a plan do the hands on the inspiratory no it'll be alright watch out for me you wanna go out hello hello there you're welcome hello hello yeah I'm good I've got this lovely 21 year old lady she's very poorly she's a gp she's had some could she did she have any ecg is that right because she's going quite fast on some of the blood tests which 1 can I do bethany natty obviously I don't think she's been preoccupied is she next 1 for preoccupied she's med I don't know if needs enough to treat her and stuff but I appreciate the support is that alright yeah do you know those gloves that you put on did I put them on my hat no the other 1 the other 1 what did I do well who was it yeah we'd already done that oh had you sorry was a mug yeah so I just didn't know if you wanted anything special I don't need more than what I did just if you've already done this fine yeah we we do our do the basin we do our in oh do you I didn't know that so request so what I mean so now your request are outstanding okay can we just delete them it's up it's up to you I'll delete them yeah we can delete them yeah it's fine just look at order all for me I just made sure there was impression is acute severe ulcerative colitis with evidence of systemic involvement with hypoalbuminemia anemia related to inflammation and raised crp aki flare of ibd associated arthritis and extraintestinal involvement with erythema nodosum and hidradenitis suppurativa plan