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35 year old female shop assistant presents with “diarrhoea for five months”
35 year old female shop assistant presents with “diarrhoea for five months”
Consistency of stools
Frequent, small-volume, bloody stools => Inflammatory diarrhea. May be accompanied by tenesmus; fever; severe abdominal pain.
Idiopathic IBD (inflammatory bowel disease), e.g. Crohn disease/ulcerative colitis. Other sx: awakening from sleep; lower abdominal pain; passage of mucus; feeling of straining, urgency, incomplete evacuation; happened gradually; reactive arthritis after infection
Ischemic colitis. Other sx: nausea; pain, tenderness or cramping in belly which occurs suddenly or gradually
Infectious processes, e.g.
C. diff
(abx use), CMV, TB,
Entamoeba histolytica
. Other sx: fever; travel hx; lower abdominal pain; sudden onset
Hemorrhoids. Other sx: itchy/painful lump or swelling near anus; painful bowel movements.
Generalized abdominal pain => Irritable bowel syndrome (IBS). Other sx: pain relieved after bowel movement; passage of mucus; abdominal bloating; increased amount of flatus; feeling of straining, urgency, incomplete evacuation; happened gradually
Greasy, bulky stools, oil in toilet bowl that needs brush to remove => fatty stools. Other sx: weight loss
Malabsorption, e.g. celiac disease. Other sx: abdominal bloating; increased amount of flatus in carbohydrate malabsorption; sx after eating rye, wheat, barley
Maldigestion, e.g. chronic pancreatitis. Other sx: excessive belching and flatulence; bloating; abdominal pain
Small intestinal bacterial overgrowth (SIBO). Other sx: nausea/vomiting; bloating; weight loss; joint pain
Cirrhosis. Other sx: jaundice; easy bruising
Watery diarrhea
Peptide-secreting endocrine tumour. Other sx: enlarged nodular liver; skin flushing; wheezing.
Correlation of sx with milk production ingestion => Lactose intolerance. Other sx: abdominal bloating
Other history
Psychiatric issues => factitious diarrhea, e.g. laxative abuse
Medications => explore drug-induced diarrhea.
Family hx of colon cancer, IBD, MEN, celiac disease
Food consumption
Sx persist if stop eating => secretory diarrhea
Contact hx -> food-borne outbreaks
Other sx
Weight loss greater than 5lbs with normal appetite => hyperthyroidism
Weight loss prior to diarrhea => neoplasm; DM; TB; malabsorption