Case Study 22/11/16 - 1Created by:
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 ?