Discussions By Condition: Gastrointestinal conditions

Case study: can anyone help me with this??

Posted In: Gastrointestinal conditions 1 Replies
  • Posted By: jeffersonjared
  • September 8, 2009
  • 02:29 PM

I need to know what causes his symptoms?
What is the cause of the bloody stool?
Condition of the patient?
Are there any medication interaction?

Salient Features of the Case:
45 y/o, married male with a chief complaint of bloody stools
PE: BP – 90/60; RR – 18/min; HR – 60 bpm; Temp = 37.8°C
Pertinent Physical Examination Findings:
Pupil – slightly jaundiced
Abdomen – globular abdomen, with spider angiomas
Ext: (+) varicosities, Grade I bipedal edema
Rectal Exam: (+) blood on tactating finger, no masses with bloody stools

Past Medical Hx:
• Diagnosed to have Pulmonary Tuberculosis 4 months ago currently on RHES with good compliance and follow ups check up
• Currently on the following medications
Omeprazole 40 mg/cap; cap OD since 4 months ago
Sangibion ( contains ferrous gloconate, manganese sulfate, copper sulfate, folic acid, sorbitol, vit c) 1 tab once daily x 2 months since 4 months ago
Epoietin alpha once weekly since 1yr ago
• High doses of multi-vitamins containing Niacin – intermittent

Social Hx:
• Alcoholic beverage drinker since 20 years of age
drinks Rhum every morning

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1 Replies:

  • Ok, what u have in front of you is a clinical picture. We know that he came in2 hospital with blood in stool. It might be useful to know whether it is bright red or slightly black colour. Does she have any recent change in bowel habit? How does the symptom of bloody stool his life, does he have pain when she defecates? Does he ever have anal sexual intercourse that could potentially lead to bleeding? All these things sound trivial, but what basically happens is you need to be able, as a physician treating him, have a clear clinical picture of what could cause the problem of bloody stool. Because what follows is you might have to order the test to confirm or substantiate ur diagnosis. Reasons I ask this is a recent change in bowel habit with bloody stool is usually indicative of bowel cancer (mayb unlikely this age group of under 60+) but we could still not rule that out. While a simple bloody stool could simply indicate haemorrhoid or ulcerative collitis or Crohn's disease.What I think might be useful for you is to have a set of tests ready so you could either have further information about clinical picture or think about substantiating ur diagnosis.- FBC: he would be very likely to develop hypochromic, microcytic anaemia due to the blood loss. However, u also mentions shes jaundice n appears to be alcohol dependent, therefore she might be folate deficiency or B12 n that could lead to macrocytic anaemia. U have more info to work with there- LFT: she appears with scleral icterus so I think chances are u might find some abnormality there. However, what im getting at is the level of damages been done. - EUC- Abdominal ultrasound- Abdominal X-ray- A potential colonoscopy- Blood Clotting study: Hope it helpsI could give you a provisional diagnosis based on what u gave me that he appears to have portal hypertension caused by chronic alcohol use. What happens with chronic alcohol use is it usually leads to lack of vitamin K production in the liver n that means u r more likely to get bleeding. Now saying that DOES not mean he does not have any other problems that causes his blood stool such as Crohn's, UC, bowel cancer or simple haemorrhoid.Good luck with this case, man
    Anonymous 42,789 Replies
    • January 28, 2011
    • 11:39 AM
    • 0
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