Gastroenterology - Luminal Cases

Question 1

Case One:
64 year old post-menopausal lady
Malaise, fatigue and breathlessness
Microcytic anaemia
Haemoglobin of 75 & a low ferritin
No gastrointestinal symptoms
No relevant family history
No signs of GI (or other)
bleeding. 
Normal examination 
- What type of anaemia is it?
- What investigations does she need?
- What are the most likely diagnoses?
- What would be different if she was 34?

Answer 1

Microcytic - Iron Deficiency Anaemia
Investigations needed - Complete blood count (CBC). Additional tests may be ordered to evaluate the levels of serum ferritin, iron, total iron-binding capacity, and/or transferrin.
Most likely diagnoses - Dietary causes (Vegan/Vegetarian diet), Low grade bleed (no sign of bleeding), Inability to absorb iron
At 64 - query cancer. At 34 - menstruating

Question 2

Case Two: 
23 year old accountant 
8 week history of diarrhoea, BO x4
Nocturnal symptoms
Bright red blood on the paper
Pain free, afebrile
Blood tests including electrolytes, full blood count and c-reactive protein (CRP) are all normal.  
- What are the differentials?  
- What investigations are needed? 
- How would this change if he was 63?

Answer 2

Differentials - Ulcerative Colitis, Crohn’s Disease, IBS - (but nocturnal?), Infection (but long standing?)
Investigations -
How would this change if he was 63?