Question

A 29 year old woman presents with several month hx of abdominal cramps, diarrhea, and 5lb weight loss of several months duration. Bloody diarrhea began this morning. Hx and physical are otherwise unremarkable. She is diagnosed with ulcerative colitis and placed on chronic therapy. She stabilizes. 2mo later, she returns to ED acutely ill, with recurrence of bloody diarrhea, abdominal pain, and distension. Her temp is 101, BP stable and normal, HR 120. Abdomen is distended and acutely tender. Her upright CXR shows free air. what do you do?

Answer 1

This patient with ulcerative colitis presents with acute symptoms including bloody diarrhea and abdominal pain. The presence of free air on an upright CXR raises concern for a possible perforation. Immediate medical attention is required, and consultation with a gastroenterologist or general surgeon is necessary.

Step-by-step explanation:

This patient's symptoms and history suggest that she is experiencing a flare-up of her ulcerative colitis. Ulcerative colitis is an inflammatory bowel disease that causes inflammation and ulcers in the colon and rectum. The symptoms of ulcerative colitis include abdominal cramps, diarrhea (often bloody), and weight loss.

In this case, the patient's acute presentation with bloody diarrhea, abdominal pain, and distension, along with the presence of free air on an upright CXR, raises concern for a possible perforation of the colon. Perforation is a rare but serious complication of ulcerative colitis that requires immediate medical attention.

The appropriate course of action would be to consult with a gastroenterologist or general surgeon for further evaluation and management. The patient may require surgical intervention to address the perforation and any associated complications.