Inside

A 20-year-old woman presents with a one-week history of blood and mucus diarrhea and generalized cramping abdominal pain. She has felt weak since waking up today. There is no history of fever.

She was diagnosed with ulcerative colitis five years ago, for which she is currently on maintenance therapy with oral mesalazine 2.5 g QD. She has no other co-morbidities. She is not on any other medications, including over-the-counter supplements. Her surgical history is unremarkable.

She does not smoke or drink and is currently on a normal diet.

Select Relevant Investigations
Complete blood count + serum electrolytes

Performed

WBC: 8,400/mm3 (4,600-11,000)
Hb: 10.8 g/dL (11-16)
Hct: 34% (35-45)
Plt: 440,000/mm3 (150,000-450,000)

Na+: 150 mEq/L (135-145)
Cl-: 110 mEq/L (95-105)
K+: 3 mEq/L (3.5-5)
X-ray abdomen

Performed

The transverse colon is dilated to 9 cm in diameter, with a loss of haustral markings.
Stool microscopy and cultures

Performed

Stool microscopy is negative for amoebae, ova, or cysts. Culture results will be available in 48 to 72 hours.
Colonoscopy

Performed

You realize that a colonoscopy is not a good idea right now.

Select Relevant Management
IV Fluids
Corticosteroids
Early surgery
Loperamide