Abdominal cramps with watery diarrhea

Chief complaint 44 y/o female presents with abdominal cramps with 9-10 episodes/day of watery diarrhea for 10 days. Description No complaint of fever or vomiting. Patient had clindamycin for 1 week prior to the episode of diarrhea and abdominal pain. Vitals Vital signs were stable. Lab reports Exam shows right upper quadrant tenderness. Labs shows leukocytosis, mild hypokalemia & normal Cr. A CT scan of abdomen and pelvis shows pancolitis. Diagnosis Please comment on the diagnosis and treatment



This patient presented with loose motions CT scan shows typical TARGET SIGN It is marked by Red arrow Target Sign. Contrast-enhanced axial CT of lower abdomen in patient with inflammatory bowel disease demonstrates three concentric circles representing hyperemic mucosa and muscularis/serosa as inner and outer high density rings and submucosal edema in the central, low density ring. There is generalised thickening of colon as depicted by white arrow Differential diagnosis Ulcerative colitis Typhlitis Portal hypertension Adv Sigmoidoscopy and biopsy for confirmation of diagnosis

Patient gone through severe dehydration with electrolyte imbalance Correct hypokalemia and treat with higher antibiotic with metrogyl See for ecg See blood report with amylase and lipase Ct shows pancolitis means ulcerative colitis in this there is involvement of renal also as seen in ct That's is might be nephrolithiasis or tubointerstitial nephritis or glomerulonephritis or amyloidosis See the report and treat accordingly Correct electrolyte imbalance

Even though CT scan shows pancolitis, the acuteness of the disease and short duration of symptoms is more s/o infective colitis and IBD is less likely in this situation (although, this might be a first episode of IBD) H/o clindamycin makes C. difficile infection more likely Treat with antibiotics and if not responding then go for flex sigmoidoscopy with biopsy as changes of IBD take atleast 2 weeks to manifest on histology.

Colicky pain with watery loose motions and lab showing hypokalamia Likely viral enterocolitis as scan shows oedematous colons submucosal swelling R/o covid19 infection Treatment include correction of electrolyte imbalance and correct hypokalamia Adv for Rifaximin and meteronidazole Imodium 250mg Racecordil may also be used

Colonic walls oedematous colitis with ? Intussaption

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