Case Discussion

Created by:

8 Jul 2016 - General

35 years old causasian female, presenting with worsening bloody diarrhoea for 1 month. It started around a month ago with few episodes of diarrhoea (3-4) a day.  But the symptom was worseing in the last week, with bloody diarrhoea, frequency aorund 7-8 times/day, with nocturnal diarrhoea. It also associated with intermitent abdominal crampy pain, reduced in appetite, lethargy and general weakness. No recent travel history,and no recent sick contact. Patient has no significant past medical history and is not on any regular medication. There is no signifcant family medical history. On examination, abdomen is general soft with slight tender throughout, no sign of surgical abdomen. Cardiovascular, respiratory and neurology examination were unremarkable. What will be your differential diagnosis ?? Diagnostic work-up ?? Treament options?  

By now the patient should be managed by a gastroenterology and not me. Assuming zombie apocalypse wiped out all gastroenterologist and I am left with the patient, I will start her on intravenous ciclosporin 2mg/kg/day and refer colorectal surgeon( He survived the apocalypse with me ).Patient is a young lady at 35 years old so a decision of surgery and likelihood of stoma bag may not be easily acceptable. Need to refer her for early counselling with regard to need for left hemicolectomy and ante...
 (Total 128 words)
This patient has no fever. Full blood count showed Hb of 8.3, CRP 35, ESR 21, normal renal and lover function, stool culture and sensitivity was negative, also negative for C.Diff. PFA showed no toxic megacolon, no evidence of perforation on erect chest x ray. Subsequently she had flexi-sigmoidoscopy showed loss of vasculature pattern, oedematous colonic mucosa, with severe erythema and ulceration (from rectum to descending colon), impression was Inflammatory Bowel Disease. Biopsy obtained for h...
 (Total 130 words)
Given her age, race and lack of travel and family history, inflammatory bowel disease-ulcerative colitis or crohn disease, is the likely diagnosis. Is the patient stable and has she got any fever? Of course other possibilities include diverticulitis, colon cancer and dysentery. I will check for arthritis, uveitis, perianal disease-i.e fistula, sinus, abscess. Diagnostic workup- complete blood count, ESR CRP, renal panel, liver panel, group and cross match, stool culture, ova and cyst as well as...
 (Total 152 words)