Jordan James is a 25-year-old male. Jordan has been admitted to hospital with a five-day history…

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 bilious 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 three weeks.

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 — Urinalysis: specific gravity: 1035; dark coloured urine; 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.