abdominal pain

Severe abdominal pain with bloody diarrhea at a frequency of twenty times per day can be a sign of a serious condition. In fact, the healthcare team should treat the issue as a medical emergency given the possibility of a life-threatening illness (Holtz, Neill & Tarr, 2009). Immediately I would question the patient regarding her medical and family history, including questions related to whether or not this was the first time she has experienced these symptoms. I would also inquire about the patient’s recent travels because it is possible the symptoms point to an infectious disease or a food-borne illness. Whatever the situation, the patient must first replenish the depleted fluids and electrolytes immediately during the administration of diagnostic procedures and patient monitoring. Also, it would be important to find out if the patient is on any medications including antibiotics, and whether or not she was pregnant. Some medications can cause acute diarrhea.
Because the patient has only experienced the symptoms for two days, this case can be considered acute. It could be caused by a temporary bacterial or viral infection or it could indicate the initial manifestation of symptoms of a more serious illness. If foodborne virus or bacteria had triggered the condition, then the patient should recover within a few days. If symptoms continue, though, the patient may indeed have a chronic condition. Diagnosing the patient’s condition will be challenging due to the great array of causes for bloody diarrhea especially during the acute stage (Holtz, Neill & Tarr, 2009). Blood, urine, and stool tests could help narrow down the causes, but it will take some time for the laboratory analyses to yield their results. The tests would screen for the most common sources of infection including Escherichia coli (E coli) and salmonella. If other patients in the same geographic area have also been reporting similar symptoms, then it may point to a temporary infection.
Vital signs and body temperature should of course be taken immediately, as well as testing for abdominal tenderness. Whether or not nausea and fever were also present could have a bearing on the diagnosis. An abdominal radiograph could be one of the initial procedures recommended, especially to rule out the presence of air in the colon. However, an abdominal ultrasound or an abdominal computed tomography (CT) scan would prove even more effective in rendering an accurate diagnosis in this case. These tests would help identify possible signs of colonic disease such as colitis (Larsen, Nakamura & Bhagra, 2012). Depending on the results of the CT scan, further tests such as barium enema, colonoscopy, and mesenteric angiography would confirm the diagnosis. Other possible diagnoses might include Crohn’s Disease and Ulcerative Colitis, both of which do affect women in this age group (LaRocque & Harris, 2019). The patient in this case is too young for other bowel conditions like diverticulitis and even colorectal cancers (Holtz, Neill & Tarr, 2009). While there are no known cures for Crohn’s disease, colitis, and other chronic conditions, the healthcare team can make recommendations for symptom management. In the meantime, the case should be considered chronic until the patient can be monitored longer.
Treatment would of course depend on the presumptive cause. Initial treatment interventions would center on restoring the patient’s fluids. Immune system dysfunction and genetics may play an important role in the etiology of the disease. Family history of conditions like colitis or inflammatory bowel disease could indicate the possibility for these conditions. Causes could be numerous including exposure to pathogens. Therefore, the patient is recommended a clean diet to reduce exposure to pathogens. Only if a pathogen has been identified in the laboratory reports should antibiotics be administered. Otherwise, the patient should be monitored until the results of the blood and stool tests return. Preventing the condition would depend on its causes. If the condition were due to a chronic and heritable condition like Crohn’s disease or colitis, then the patient will need to engage in lifestyle changes to regulate symptoms but if the patient is merely experiencing a temporary illness due to a pathogen, then the patient could be recommended techniques related to food safety and hygiene.
References
Holtz, L.R., Neill, M.A. & Tarr, P.I. (2009). Acute bloody diarrhea. Gastroenterology 2009(136). Retrieved from: https://www.gastrojournal.org/article/S0016-5085(09)00344-8/pdf
LaRocque, R. & Harris, J.B. (2019). Patient education: acute diarrhea in adults. Up To Date. Retrieved from: https://www.uptodate.com/contents/acute-diarrhea-in-adults-beyond-the-basics
Larsen, C.M., Nakamura, K.M. & Bhagra, A. (2012). 34-year old woman with abdonaml pain and blood-streaked diarrhea. Mayo Clinic Proceedings 87(9): 905-908.