CASE 38
A 75-year-old man experienced the acute onset of severe abdominal cramps. Later in the morning, watery diarrhea occurring every 15 to 30 minutes developed, initially with small amounts of visible blood. Diarrhea subsequently became markedly bloody. He was nauseated but not vomiting. Worried about his illness and his age, his son took him to a nearby hospital emergency department for evaluation.
LABORATORY STUDIES
Diagnostic Work-Up
Table 38-1 lists the likely causes of illness (differential diagnosis). A diagnosis of hemorrhagic colitis was considered. Investigational approach may include
TABLE 38-1 Differential Diagnosis and Rationale for Inclusion (consideration)
Rationale: It is important to carefully evaluate bloody diarrhea to rule out invasive bacterial pathogens because some should be treated and others may not need to be treated. In addition, empirical use of antidiarrheal medications is not recommended for most of these syndromes. Amebic colitis is usually associated with travel; C. difficile is associated with earlier antibiotic consumption. Dysentery would demonstrate fever along with bloody diarrhea. IBD, an idiopathic syndrome, is also important to consider, although it is distinctly unusual in this age group.
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
