My Bowels Are Misbehaving

Today’s discussion focused on a 54 year old woman with hypertension and chronic pelvic pain s/p TAH/BSO presenting with lower abdominal cramping with associated bloody diarrhea. Pertinent findings were explored, including risk factors and dietary regimen to recurrence of her symptoms or review of constitutional symptoms. The case continues to where she recalls being able to tolerate chicken, rice and vegetables 2 days prior to her admission to declining to episodes of lightheadedness with an overall level of fatigue. Subsequent work-up found that she had diffuse colonic wall thickening with a positive stool culture for Campylobacter spp.

Highlights from the report included:

• Recognition that one of the initial signs of worsening hypovolemic state (i.e. acute blood loss) is reflected by tachycardia as the body strives to maintain cardiac output.
• Categorizing lower GI bleed into structural or anatomical, inflammatory (infectious or non-infectious), vascular and neoplastic etiologies
• Review of Campylobacter as one of the most common causative agents for acute diarrhea, its manifestations and whether antibiotics are always indicated

There is a nice original review in the 1980s of this enteritis giving a historical perspective to newest developments discussed in the Centers for Disease Control and Prevention. Additionally, here are some other articles referenced for your perusal (here and here).