Question

A 62-year-old man presents to the emergency department concerned about a large amount of blood in his recent bowel movement. He states he was at home when he noticed a large amount of red blood in his stool. He is not experiencing any pain and otherwise feels well. The patient has a past medical history of diabetes and obesity. His temperature is 98.9°F (37.2°C), blood pressure is 147/88 mmHg, pulse is 90/min, respirations are 13/min, and oxygen saturation is 98% on room air. Physical exam reveals a non-distressed man. His abdomen is non-tender, and he has normoactive bowel sounds. Stool guaiac test is positive for blood. The patient is started on IV fluids and kept nil per os. His next bowel movement 4 hours later appears grossly normal. Which of the following interventions will most likely reduce future complications in this patient?

a. Ciprofloxacin and metronidazole
b. Increase fiber and fluid intake
c. Reduce red meat consumption
d. Sigmoid colon resection
e. Sitz baths

Answer 1

Increasing fiber and fluid intake is the recommended intervention to reduce future complications for the patient with blood in the stool, as their condition does not suggest an acute infectious cause or the need for more invasive treatments.

Step-by-step explanation:

The presence of blood in the stool may be indicative of various conditions ranging from hemorrhoids to more serious gastrointestinal disorders. The patient's symptoms and clinical presentation do not suggest an acute infectious cause, such as C. difficile or enterotoxicogenic E. coli (ETEC), especially since the following bowel movement was grossly normal. Observing the blood pressure and history of obesity and diabetes, a high-fiber diet and increased fluid intake would likely benefit the patient's overall gastrointestinal health and help prevent future episodes related to similar conditions.

In contrast, antibiotics like ciprofloxacin and metronidazole are typically employed in managing specific bacterial infections, while more invasive interventions such as sigmoid colon resection would not be indicated without evidence of neoplasia or severe refractory disease. The patient's history does not currently support these interventions. Moreover, sitz baths are commonly recommended for relief from hemorrhoids or anorectal conditions, but not for prevention of the unspecified bleeding in this case. Therefore, lifestyle modifications targeting diet and hydration are the most appropriate next step to prevent further complications.