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Case Presentation

Case Presentation. Acute Diarrhoea. Mr AB. 24 yo man lives interstate Presents with 3 days diarrhoea and 4 days abdominal pain and feeling generally unwell. 12-15 episodes of diarrhoea a day normal colour not watery but loose ++ no blood or mucous

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Case Presentation

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  1. Case Presentation Acute Diarrhoea

  2. Mr AB • 24 yo man lives interstate • Presents with 3 days diarrhoea and 4 days abdominal pain and feeling generally unwell. • 12-15 episodes of diarrhoea a day • normal colour • not watery but loose ++ • no blood or mucous • Generalised non-specific crampy abdo pain, right worse than left, radiating to right back. • worst pain ever experienced like ‘stomach in a vice’ • No vomiting, no fevers/sweats/rigors. • Loss of appetite.

  3. Past Medical History • Gastroenteritis one year ago – 24 hr bug • Gastritis – 18yo – took Somac for a while Medications • No medications or allergies Family History • Parents and sister (25) well Socially • No infectious contacts, • Just quit smoking 3 pk/wk, w/e ETOH binges • Ate a ‘dodgy’ chicken schnitzel on Friday at shopping centre

  4. Examination • HR 100, BP 100/70, T 364, RR18, Sats 100%RA • Looks unwell but not distressed or haemodyn. compromised. Soft abdo Right sided and bilateral IF tenderness No renal angle tenderness Mild RIF rebound No organomegaly BS increased

  5. Examination II • Stong Pulses, Dual Heart Sounds, no murmurs • Chest Clear • MMM, normal turgor, warm to touch, appears well perfused, thirsty • FWT – NAD • BSL – 4.6mmol

  6. FBE

  7. Other Bloods

  8. Abdo XR

  9. Questions • Any other questions or examination points? • DDx? • Plan?

  10. Progress • Analgesia • Pain well treated though not completely relived by Panadol and Buscopan • IV Fluids • HR 75, BP 120/80, T 373 • Admit Surg – Single Room • Observe ?appendicitis DDx gastroenteritis • Faecal Spec for MCS collected in ED • Loose brown sample, occasional WCC, RBC+ • Overall feeling much better on PM WR.

  11. 21/7/2006 – AM WR • Little change: • few bouts of diarrhoea overnight • crampy abdo pain persists on right side though not guarding as was yesterday • still no temperature above 373 • feels hungry • Dilemma: • definitive diagnosis of appendicitis can really only be made on laparoscopy • What to do now?

  12. Repeat Bloods

  13. Repeat Bloods

  14. CT Abdo/Pelvis

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