Bloody Diarrhea

Question 1

A 55-year-old male patient with abdominal pain and bloody diarrhea. His vital signs are: BP 90/60, pulse 130Bpm, temp 38. After admission had additional episodes of bloody diarrhea which stopped 6 hours later. Intial resuscitation done with IV fluids. Lab results:Hb 8.8, plt 666000, WBC 12000, Na 120. K 2.8, CRP 100, high creat and urea.

Q1: What can you see in this blood picture?

Answer 1

Anemia, leukoctyosis and thrombocytosis

Question 2

Q2: What’s the type of anemia in this case?

Answer 2

Microcytic, hypochromic

Question 3

Q3: What’s your comment on this platlet count?

Answer 3

Increased

Question 3

Q4: What are the causes of thrombocytosis in

Answer 3

as a part of Acute phase reactants
NB; Acute Phase reactants – > +ve (Ferritin, CRP, Amyloid) , -ve (albumin)
this case

Question 4

Q6: What are the common causes of bloody diarrhea?

Answer 4

Infection (ameobic colitis, Dysentry, Nec. Enetrocolitis, C.defiicile)
Inflammation (UC, Crohn’s)
Cancer

Question 5

Q8: What has caused the mentioned electrolyte disturbances in this patient?

Answer 5

Most probably from diarrhea as he is inflammation

Question 5

Abdominal X-ray was done.

Q5: What can you see?

Answer 5

Dilatation of the ascending colon and narrowing in desc. Colon with Thumb printing sign (radiographic sign in large intestine showing due to infection or inflammation)

Question 6

Q7: In view of blood loss and hypotension, would you give this patient blood? Why?

Answer 6

No, As Hg is > 7 and pt is septic also

Question 7

Q9: Apart from these lab tests and X-ray, what are the other tests you would like to request?

Answer 7

Labs; ESR, CRP, Stool culture and analysis and Calprotectine
Abs; like ANCA ASCA
Img; US/CT
Colonscopy if suspected malignancy will take biopsy ( after inflammation subsides)

Question 8

Q10: How would you know that patient’s improving?

Answer 8

Clinically; improving in vital signs and diarhhea stops and normal phase reactants
Labs; normal FBC

Question 9

Q11: If the cause of diarrhea is IBD, when surgical intervention would be an option?

Answer 9

IF there’s Toxic Megacolon, Fulminant attack, Uncontrolled bleeding and there’s obstruction with suspicion of malignancy

Question 10

Q12: What’s the procedure of choice?

Answer 10

Acute – > Subtotal colectomy with ileostomy