General

CaseStudy_211116 - 2

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21 Nov 2016 - General
 

An elderly gentleman, with background of previous ischaemic heart disease, previous stroke, osteoporosis, rheumatoid arthritis, hypertension, mild cognitive impairment, and hypothyroidism, was admiited to hospital due to general unwell for 1 weeks, with 4 days history of intermittent palpitation, and 1 day history of generalised abdominal pain, and few episodes of fresh PR bleeding together with few episodes of diarrhoea. On examination, patient was noted to have irregular pulse. Examination of abdomen showed generalised pain. ECG showed that he had new onset atrial fibrillation, with the rate of around 90 per minute. Blood tests showed that Haemoglobullin (Hb) was low at around 8.5, with slightlye elevated CRP of 25. Stool sample for culture and sensitivity and stool sample for clostridium difficile were all negative. What is your working diagnosis for his fresh PR bleeding with diarrhoea ??