TOPIC: BOWEL CHANGES
Summary of disease
Epidemiology
Pathogenesis and related
(patho)physiology & pathology
Important features in history and
timeline
Symptoms and signs in physical
examination
Differential diagnoses to be
considered alongside this
condition
Investigations of Importance to
Rule In Diagnosis and to Rule
Out other diagnoses
Acute management
Initial Walk-In Management
[Non-acute]
Long term Management
Updates on Diagnosis
Updates on Management
Prognostic factors and current
prognosis with current
management strategies
Importance in Public Health
Related Pre-clinical Topics to
Revise
1. Passing watery reddish stool (dark red) + incomplete sense of emptying
2. l\blood mixed with stool
3. abdominal pain on right side better after emptying – rate the pain 5/10, not persistent
4. does the pain follow any meal patterns? Dull aching pain
5. no nausea or vomiting
6. no fever
7. only malaise
8. returned from India (had flu over there, given co-amox; felt better after antibiotics – full course;
prescribed by GP)
9. loose stool watery (wt\ithout blood) for past 4 months, appears most days; previously well
10. fhx sister – colon cancer – died (unsure age, 40s)
11. no LOA but LOW (UNINTENTIONAL)
12. no other medications and NKDA
13. no prev sgx
14. smoker – 15 pack years – tried to stop once but failed ; has thought about it
15. no alcohol intake
16. not sexually active
17. no ROS such a chest pain, SOB, cough, joint and back pain, conjunctivitis, blurring of vision
18. GIT symptoms: no dysphagia but has mouth ulcers (frequent – self resolving; has not consulted dr
about this before – worsen in past 4 months)
19. Should enquire more GIT symptoms such as JAUNDICE
20. Did well to enquire about constipation, bloating, gastric pain, vomiting blood
21. has red nodules, painful, on both legs (shins)
PE exam
Noted anemia
Well hydrated
1. Crohn’s – chronic bloody diarrhea with loss of weight (malnutrition) + extra colonic (erythema
nodosa and mouth ulcers) + smoker
2. Ulcerative colitis
3. Infectious colitis
4. Pseudomembranous colitis – how long before it manifests?
1. Crohns – colonoscopy - cobblestone; UC – pseudopolyps [if no consent for colonoscopy, double
Barium enema or CT scan]
Rare to present acutely – usually subacute unless Crohns of distal colon – usually referred after
months of diarrhea
Tenesmus – high suspicion of rectal disease (incomplete evaculation – poor contractility)
From this case, 2 sites – ileocecal and anorectal
2. RP – hypokalemia due to diarrhea
3. CRP
4. LFT – PSC
5. Serum folate and B12 for nutritional
6. Stool microscopy and culture – c. diffcile TRO pseudomembranous
7. Fecal cow protein – IBS vs IBD
8. PFA
1. Address diarrhea
2. Consent for colonoscopy
Images
Diagrams and algorithms
Interesting Facts
OSCE
MEQ