35: Diarrhea
A 31-year old female presents with 5 days of abdominal pain and diarrhea, now with blood. She states she has had a few similar episodes in the past, but this is worse. She has never seen a doctor for it. She is otherwise healthy.
On exam her vitals are normal. She is tender in the right lower quadrant. Rectal exam shows a small amount of stool with a little gross blood.
Her UA and pregnancy tests are negative. Her CBC is normal except for a mild microcytic anemia with a hemoglobin of 10.1. LFT’s and metabolic panel are normal. A CT scan is ordered and one cut is shown below. What does it show? What is the significance.
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Answer: Sclerosis of the Sacro-Iliac joint
This CT shows Sacro-iliitis which when it co-occurs with bloody diarrhea is highly suspicious for Inflammatory Bowel Disease. The CT also showed a bladder stone and an appendicolith, but no evidence of acute appendicitis. The patient was diagnosed with Ulcerative Colitis.
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EXCERPT ON INFLAMMATORY BOWEL DISEASE
from
QUICK ESSENTIALS EMERGENCY MEDICINE
Basics:      Idiopathic inflammatory. Onset usually age 35-50. Bloody diarrhea, pain.
Comps:Â Â Â Â Â Anemia, obstruciton, cancer, arthritis, uveitis, kidney stones
Skin:Â Â Â Â Â Â Â Â Â Erytema nodosum, Pyoderma gangrenosum
Rx:            Steroids, asacol, flagyl, remicade…
Surgery: Â Â Â Refractory bleed, obstruction, perforation, abscess, megacolon
Dispo:Â Â Â Â Â Â Â Â Admit: bad electrolytes, fever.
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