Case Study 22/11/16 - 1

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22 Nov 2016 - General

A middle aged lady, with background of previous twice small bowel resection surgery due to Crohns disease (last surgery 1 year ago, and not on any medication for her inflammatory bowel disease), hypothyroidism, hypertension, and smoker of 20 pack years, was admitted due to 4 weeks history of increased bowel motion, ranging from loose soft stool to waterry stool, with the frequency of around 5-6 times a day. There was no blood in the diarrhoea, no fresh PR bleeding. There was no abdominal pain. Blood tests including full blood count, inflammatory marker (CRP), liver function, and renal function were normal. X-ray of her abdomen was normal. Stool sample for culture and sensititviy and for C.Diff were normal. Colonosocpy to neo-terminal ileum was normal, with normal colonic and small bowel histology. MRI-small bowel showed post -operative changed of small bowel. What is your working diagnosis for her cause of diarrhoea ? What is your management plan ?

This patient has bile acid malabsorption, leading to diarrhoea. Patient with small bowel or ileal resection will cause the bile acid transporter in the small bowel been removed. The excess bile acid will go into the large bowel. When the concentration of bile acid in the large bowel reaches the critical level of around 3 to 5 mmol/L, salt and water absorption by colonic mucosa is inhibited and this will lead to diarrhoea. This is the most likely cause for this patient with 2 previous small bowel...
 (Total 110 words)
This is a case of Short Bowel Syndrome. This condition is related to poor absorption of nutrients and it typically occurs in people who have had part of their small intestines surgically removed. It is characterized by significant damage of the small intestine therefore causing poor motility.
People with short bowel syndrome cannot absorb enough water, vitamins, minerals, protein, fat, calories, and other nutrients from food. A battery of laboratory and diagnostic imaging exams that include ...
 (Total 103 words)