RT Book, Section A1 Hankin, Mark H. A1 Morse, Dennis E. A1 Bennett-Clarke, Carol A. SR Print(0) ID 1145872219 T1 Neck T2 Clinical Anatomy: A Case Study Approach YR 2017 FD 2017 PB McGraw-Hill Education PP New York, NY SN 9780071628426 LK accessphysiotherapy.mhmedical.com/content.aspx?aid=1145872219 RD 2024/03/29 AB Patient PresentationA 40-year-old male is admitted to the emergency department complaining of severe diarrhea, vomiting, dehydration, weakness, and weight loss. He is malnourished and a central venous catheter is placed to provide parenteral nutrition.Relevant Clinical FindingsHistoryThe patient reported losing 25 lb during the past 9 months. The patient has a history of Crohn disease, with two previous resections of his small intestine. This has resulted in short-bowel syndrome, characterized by malabsorption, diarrhea, steatorrhea, fluid and electrolyte disturbances, and malnutrition.Clinical NoteCrohn disease is a chronic, autoimmune, inflammatory disease that affects the gastrointestinal tract, usually the intestines. It results in transmural fibrosis and obstructive symptoms.Physical ExaminationNoteworthy vital signs:Height: 5′ 10″Weight: 120 lbResults of physical examination:Diffuse abdominal tendernessFirmness in the right lower abdominal quadrant (consistent with appendicitis; or Crohn disease, which most commonly involves the terminal ileum)Laboratory TestsTable Graphic Jump Location|Download (.pdf)|PrintTestValueReference valueErythrocyte (count)3.64.3–5.6 × 106/mm3Hematocrit32.238.8–46.4%Hemoglobin1014–17 gm/dLSerum albumin3.24.0–5.0 mg/dLImaging StudiesPlacement of a central venous catheter, introduced via the right internal jugular vein, was confirmed radiographically.Clinical Problems to ConsiderInternal jugular vein catheterizationSubclavian vein catheterization