Gastroenterology
Case 23: A Patient with Bloody Diarrhoea
CASE
A 34‐year‐old woman is admitted to hospital with 72 hours of severe bloody diarrhoea. She had been fit and well the previous week but had taken ill 24 hours after dining out with friends at a local restaurant. No one else in the party was affected. Initially she felt nauseated and then developed frequent loose stools associated with severe, cramping lower abdominal pain. She has been having her bowels open every hour and was up in the night 5 or 6 times. She has no significant past medical history but takes the oral contraceptive pill and uses proton pump inhibitors (PPIs) on an as‐needed basis for reflux symptoms. Her mother has ulcerative colitis.
On examination she looks unwell. She is febrile with a temperature of 39.2°C. She has dry mucous membranes and is tachycardic with a pulse of 110 beats/min. She is hypotensive with a BP of 80 mmHg systolic and feels light headed when sitting up.
Blood tests showed:
Hb 13.8 g/dL WCC 22.1 × 109/L Platelets 198 × 109/L Na 145 mmol/L K 2.7 mmol/L Urea 11.4 mmol/L Creatinine 130 µmol/L
Plain abdominal X‐ray shows an empty colon with marked mucosal oedema and thumb‐printing.
QUESTION 1
Your score this session: 0 of 0
The most likely cause of this presentation is: