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Diarrhea & BUQ Pain

UnFiNiShEd CaSe CoMe BaCk LaTeR

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History of Present Illness:

A 52-year-old female with HTN, DM, ESRD and GERD on insulin, lisinopril and Prevacid presents to the ED for 10 days of diarrhea and 2 days of constant BUQ pain.  She denies any fever, bleeding, vomiting or other complaints.

Vital Signs & Physical Exam:

Vital signs are normal except for a pulse of 112.  BP is 92/47.   Physical exam is normal except for BUQ tenderness with mild voluntary guarding.

Initial Differential Diagnosis: 

  • Gallstones
  • Gastritis
  • AGE
  • Colitis

Relevant Test Results:

  • EKG: none
  • Labs: none ordered
  • Imaging: see CT below

QUESTIONS:

  1. What does the case image show?  
  2. What should you do next?  
  3. Want a 1-minute consult/tutorial on this case? 
  4. Want to know what happened with this patient?

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ANSWERS:

  1. What does the case image show?  The image shows colitis of the transverse colon.  This could be pseudomembranous colitis.
  2. What should you do next?  Treat with Zithromax and Flagyl to cover typical bacterial causes of diarrhea while avoiding quinolones.  Give IV fluids to normalize vitals or at least until the SBP is higher than the pulse..  Test for c. dif  among other pathogens.  Admit patient.
  3. Want a 1-minute consult/tutorial on this case?  See yellow area from sample page below.
  4. Want to know what happened with this patient?  See case conclusion below tutorial page.

1-Minute EM Consult on the topic for this case from the Emergency Medicine 1-minute Consult Pocketbook

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CASE CONCLUSION: We’ll just have to see

CASE LESSONS:

  1. Always
  2. Never
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