Gastroenterology Masterclass

Karen is 32 years old. She presents with increasing frequency of bowel motions over the last 2 months.

She returned from Egypt about 10 weeks ago but was not unwell on holiday, apart from 2 days of loose motions when she arrived. She was staying in hotels and did all the usual tours including a camel ride.

She is now going between 4 and 6 times daily. The motion is watery with some solid elements and there is some slime and mucus. There is red and darker blood streaking in nearly all the motions. She has nocturnal diarrhoea. She has some left sided pain, which is dull and persistent but occasionally colicky. She has lost about half a stone over the 2 months.

She is otherwise well – had her appendix removed as a teenager – and her only medication is the oral contraceptive pill. She is single, works for a computer software company and has no children. She lives with her partner who went on the holiday but has had no ill effects.

On examination, her abdomen is quite tender all over but most on the left side. Rectal examination shows no masses but there is some blood mixed with the motion. Investigations show no growth on faecal culture on two occasions. Hb is 11.8 with a normochromic normocytic picture, her wbc is slightly raised with a neutrophilia, ferritin is 18, viscosity is 1.82 and CRP is 28.

Questions

a) What aspects of this story suggest that this is an organic diarrhoea, rather than a functional diarrhoea?

b) How would you manage the finding of negative stool cultures?

c) Would you initiate any treatment, and if so what?

d) How would establish the diagnosis?

e) What is the long term care and management of the condition?