General

CaseStudy_191116 -

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19 Nov 2016 - General
 

A middle aged gentleman, with background of hyperternsion, type 2 diabetes mellitus, chronic kidney disease, hypercholesterolaemia, previous ulcerative colitis with pan protoc-colectomy with end ileostomy, and smoker with 30 pack years history, was admitted to hopsital due to 4 days history of increased in his stoma output. The content of his stoma output became more waterry, and incrased in volume. He needed to emptying it at least 9-10 times in a day. His usual stoma output will be loose soft stool. There was no blood in the stoma output. There was no abdominal pain, no nausea and vomiting. He was abkle to tolerate oral intake. On examination, his abdomen was soft and non tender. The imflammatory marker (CRP) was slightly elevated at around 25, with acute on chronic renal impairment. What is your differential diagnosis ? What are your investigations plan ?