EM H&P 3

Chief Complaint

“Diffuse abdominal pain and diarrhea” x 1 day

History of Present Illness

68-year-old female with a past medical history of hypertension and hyperlipidemia and a past surgical history of cholecystectomy, hysterectomy, and oophorectomy. She presents to the ED with complaints of diffuse abdominal pain, nausea, and seven episodes of diarrhea over the past day. She describes the diarrhea as loose brown stools with some blood at the end of her bowel movements.

The abdominal pain is crampy, diffuse, and rated 5/10 in severity, without radiation. She denies fever, chills, vomiting, bloating, or abdominal distension. She has not experienced similar symptoms in the past.

She denies recent travel or sick contacts but mentions consuming food at a senior center two days prior to symptom onset. She has not taken any medications or treatments for the symptoms prior to arrival.

Past Medical History

  • Hypertension 
  • Hyperlipidemia

Past Surgical History

  • Cholecystectomy 
  • Hysterectomy 
  • Bilateral oophorectomy 

Medications

  • Amlodipine 10 mg, PO daily
  • Atorvastatin 20 mg, PO nightly

Allergies

No known drug, food, or environmental allergies

Family History

  • Mother: Deceased(unknown)
  • Father: Deceased(unknown) 
  • Siblings: Alive and well
    No family history of gastrointestinal disorders or malignancies

Social History

  • Smoking: Never
  • Alcohol: Rare social use, 1-2 glasses of wine monthly
  • Illicit Drug Use: Denies any past or current use
  • Diet: Balanced diet, no specific dietary restrictions
  • Exercise: Occasional walks with husband
  • Travel: Denies recent travel

Review of Systems (ROS)

General: Denies fever, chills, weight changes, or fatigue
Skin: Denies rash, lesions, or itching
HEENT: Denies sore throat, visual changes, or hearing loss
Neck: Denies pain or stiffness
Pulmonary: Denies cough, shortness of breath, or wheezing
Cardiovascular: Denies chest pain or palpitations
Gastrointestinal: Reports nausea, diffuse abdominal pain, and diarrhea with blood; denies vomiting, bloating, or distension
Genitourinary: Denies dysuria, frequency, or hematuria
Musculoskeletal: Denies joint pain or swelling
Neurologic: Denies headache, dizziness, or focal weakness
Endocrine: Denies heat or cold intolerance
Psychiatric: Denies anxiety or depression

Physical Exam

Vitals: BP: 128/72, HR: 78 bpm, RR: 18, Temp: 98.1°F, SpO2: 97% on RA

General: 68-year-old female in mild discomfort due to abdominal pain, alert, and cooperative.no signs of dehydration ( normal skin turgor, moist mucous membranes)

HEENT: Normocephalic, atraumatic, PERRL, EOM intact.

Neck: Supple, no cervical lymphadenopathy, trachea midline.

Heart: Regular rate and rhythm, no murmurs, rubs, or gallops.

Lungs: Clear to auscultation bilaterally, no crackles, wheezes, or rhonchi.

Abdomen: Soft, tender to palpation in the left lower quadrant without rebound or guarding; no palpable masses or organomegaly.

Genitourinary: No suprapubic tenderness or CVA tenderness.

Musculoskeletal: Full range of motion, no joint swelling or deformities.

Neurologic: Alert and oriented x3, no focal deficits.

Differential Diagnosis

Diverticulitis

  • Most likely given the LLQ tenderness, bloody diarrhea, and abdominal pain.

Gastroenteritis

  • Acute diarrhea and nausea suggest viral or bacterial etiology, though bloody stool favors bacterial causes.

Infectious Colitis

  • Bacterial pathogens are a concern, especially with recent food exposure at the senior center.

Ischemic Colitis

  • Considered due to LLQ pain and bloody diarrhea, particularly in older adults with vascular comorbidities.

Inflammatory Bowel Disease (IBD)

  • Less likely given the acute onset and patient’s age but remains a possibility.

Assessment

68 year old female with a PMHx of HTN and HLD, and PSHx of cholecystectomy, hysterectomy, and oophorectomy presenting for 1 day of abdominal pain, nausea, and diarmea.

Plan

  1. Labs
    • CBC w diff, BMP, LFTs, Lipase, GI PCR Panel, Respiratory PCR Panel
  2. Imaging
    • CTAP with IV Contrast 

Results

CTAP with IV contrast:

  • Findings of Colitis(wall thickening from the hepatic flexure of the colon to the sigmoid,and also most likely of the rectum).
  • Postoperative findings 
  • No acute appendicitis 

GI PCR: CAMPYLOBACTER SPP DNA DETECTED

#Campylobacter diarrhea associated with Colitis 

  • Start Maalox MAX 400-400-40 mg/5mL Suspension (5 mL every 6 hours)
  • Start Famotidine 20 mg Tablet (twice a day for 30 days)
  • Directed the patient to stay hydrated with oral fluids to prevent dehydration.
  • Recommend following the BRAT diet (Bananas, Rice, Applesauce, Toast) to help with gastrointestinal recovery.
  • Symptoms should improve in the next few days with treatment and hydration.
  • Monitor for worsening diarrhea, increased abdominal pain, or signs of dehydration, such as dry mouth or dizziness.
  • Return Instructions: Seek medical care if symptoms worsen, there is persistent or increasing blood in stools, fever develops, or if unable to maintain hydration.