PBL (2): Bloody diarrhea

A 25-year-old male, was in his usual state of health until 3 months ago when he  had
3 to 4 days of bloody diarrhea. The diarrhea has recurred approximately 4 times in
the past 3 months; typically, it would last for several days, then resolve.

The diarrhea was described as loose to semi-solid bowel movements occurring 4 to

5 times per day with urgency to move his bowels, and usually associated with mild
cramps and left lower quadrant abdominal pain. With each bowel movement, there
was a small amount of bright red blood. The most recent episode was more severe
and lasted longer than usual (more than 6 days). There is no history of fever, night
sweats, nausea, vomiting, abdominal bloating or distension, fecal urgency, joint pain,
and rash.

Medications: Ibuprofen 400 mg

Family history: Mother has ulcerative colitis and colonic carcinoma

Social history: He smokes about 1ppd

Physical examination: Only abdominal tenderness on palpation/percussion

Labs: Hb 12.5, HCT 36, the rest unremarkable, stool cultures are negative.
Sigmoidoscopy, biopsy and barium enema were done. Pts' physician started the
treatment and asked the patient to have colonoscopy and rectal biopsy annually.