Case Presentation Acute Diarrhoea. Mr AB 24 yo man lives interstate Presents with 3 days diarrhoea...

Case PresentationAcute Diarrhoea

Mr AB

• 24 yo man lives interstate• Presents with 3 days diarrhoea and 4 days

abdominal pain and feeling generally unwell.• 12-15 episodes of diarrhoea a day

– normal colour– not watery but loose ++– no blood or mucous

• Generalised non-specific crampy abdo pain, right worse than left, radiating to right back.– worst pain ever experienced like ‘stomach in a

vice’

• No vomiting, no fevers/sweats/rigors.• Loss of appetite.

Past Medical History• Gastroenteritis one year ago – 24 hr bug• Gastritis – 18yo – took Somac for a while

Medications• No medications or allergies

Family History

Socially• Parents and sister (25) well

• No infectious contacts,• Just quit smoking 3 pk/wk, w/e ETOH binges• Ate a ‘dodgy’ chicken schnitzel on Friday at shopping centre

Examination

• HR 100, BP 100/70, T 364, RR18, Sats 100%RA

• Looks unwell but not distressed or haemodyn. compromised.

Soft abdo Right sided and bilateral IF tenderness No renal angle tenderness Mild RIF rebound No organomegaly BS increased

Examination II

• Stong Pulses, Dual Heart Sounds, no murmurs

• Chest Clear• MMM, normal turgor, warm to

touch, appears well perfused, thirsty

• FWT – NAD• BSL – 4.6mmol

Other Bloods

Abdo XR

Questions

• Any other questions or examination points?

• DDx?• Plan?

Progress• Analgesia

– Pain well treated though not completely relived by Panadol and Buscopan

• IV Fluids– HR 75, BP 120/80, T 373

• Admit Surg – Single Room– Observe ?appendicitis DDx gastroenteritis

• Faecal Spec for MCS collected in ED– Loose brown sample, occasional WCC, RBC+

• Overall feeling much better on PM WR.

21/7/2006 – AM WR

• Little change:– few bouts of diarrhoea overnight– crampy abdo pain persists on right side

though not guarding as was yesterday– still no temperature above 373

– feels hungry

• Dilemma:– definitive diagnosis of appendicitis can

really only be made on laparoscopy– What to do now?

Repeat Bloods

CT Abdo/Pelvis

CT Report

• Severe right sided colitis extending from caecum to hepatic flexure.

• No terminal ileitis.• No skip lesions.• Suggest biopsy!!!!

AXR Report• No soft tissue definition.• Some ‘loss of definition’ within the

right sacroiliac joint.• ? inflammatory arthropathy.

Further History

• Frequently gets sore knees and shoulders from time to time.– blames it on football

• Back pain occasionally– when standing for long periods– doesn’t know if always worse on right

• No chronic diarrhoea.• No history of red eye, skin complaints,

non-axial joint pain, redness or stiffness, no mouth ulcers, no other extra-intestinal manifestations of IBD.

Progress

• Diarrhoea and pain settled and patient tolerating FWD at day two admission.

• Back pain occasional and mild.• Gastro Med Review:

– no active treatment required at this stage if symptoms improving

– requires gastro and rheum f/u– otherwise can go home– will need colonoscopy in 4-6 weeks

• GP in Newcastle was contacted.• D/C three days after admission.

Case Presentation Acute Diarrhoea. Mr AB 24 yo man lives interstate Presents with 3 days diarrhoea...

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Transcript of Case Presentation Acute Diarrhoea. Mr AB 24 yo man lives interstate Presents with 3 days diarrhoea...