Case 20: Bloody Stools

Mr Aziz is a 26 year-old Bangladeshi gentleman who presents to the emergency department with a 4 week history of bloody diarrhoea.

DSC_0673

He reports opening his bowels up to 8 to 10 times a day and this is associated with the passage of dark red blood which is mixed in with the stool.

The triage nurse in the emergency department records his observations on admission and gives them to you on a piece of paper. These are as follows:

Temperature: 38.9 C

HR: 100 bpm

BP 120/70 mmHg

RR: 18 breaths/min

SPO2: 99% on room air

His initial blood tests are already back from the lab:
Hb 9.7 g/dL
WCC 14.0 x109/L
Plt 557 x109/L
Na 146 mmol/L
K 3.1 mmol/L
Urea 7.9 mmol/L
Creatinine 78 mmol/L
Bil 25 umol/L
ALT 30 U/L
ALP 75 U/L
Albumin 30 g/L
INR 1.1
CRP 35 mg/L

ESR 37 mm/hr

Question 1. What further information would you like to know from Mr Aziz’s history and examination? 

HPC

He is complaining of generalised cramping abdominal pain, mainly in the LIF, made better by defecation.

He has lost 3kg of weight in the past month, and he is worried to eat as this seems to make his diarrhoea worse so he has resorted to just drinking liquids over the past week.

There is no history of foreign travel

No family history of inflammatory bowel disease

He does not have any joint pains, rash or ocular symptoms.

PMH

None

DH

He does not take any regular medication.

SH

He is a non smoker and does not drink any alcohol. He works as an accountant and lives with his parents. He has not travelled.

Examination

He is comfortable but has dry mucous membranes. His abdomen is soft with some mild discomfort on palpation on the left side. There is no organomegaly. Bowel sounds are normal. There are no rashes, eye problems or any joint swelling.

Discuss now on Twitter, using the hashtag #quclms. Follow @quclms for updates. Further information and follow-up questions will appear on Twitter throughout the week.

Question setter & Expert: Dr Aruchuna Mohanaruban, ST5, The Royal London Hospital

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