A 57-Year-Old Woman With Bloody Diarrhea

Derik L. Davis, MD; Harvey Stern, MD; Helen T. Morehouse, MD


August 16, 2017

Physical Examination and Workup

Upon physical examination, the patient has a temperature of 98.8°F. She has a pulse of 98 beats/min and a blood pressure of 114/72 mm Hg. Her respiratory rate is 14 breaths/min. She is well-nourished, well-developed, and in no acute distress.

Head and neck examination findings are normal, with moist oral mucosa. The patient's lungs are clear bilaterally, and the heart rate and rhythm are regular, with no murmurs. The breasts are normal.

The abdomen is mildly distended, and positive bowel sounds are observed. No guarding, rigidity, or rebound tenderness is noted. Noninflamed and nonswollen external hemorrhoids are present, and the rectum contains feces. The rectal examination reveals no abnormal tenderness, but the stool is strongly guaiac-positive. The rest of the exam is unremarkable.

Laboratory analysis demonstrates an abnormal complete blood count, with a low hemoglobin level of 10.4 g/dL (normal range, 12-16 g/dL), a hematocrit of 30.1% (normal range, 42%-51%), and a white blood cell count of 4.1 × 103 cells/µL (normal range, 4.8-10.8 × 103 cells/µL). The platelet count is within the normal range. The basic metabolic panel is normal, except for a low potassium level of 3.3 mEq/L (normal range, 3.5-5 mEq/L). The amylase and lipase levels are elevated, at 186 U/L (normal range, 16-100 U/L) and 75 U/L (normal range < 62 U/L), respectively. Liver function tests, urinalysis, and coagulation studies are in the normal range.

Abdominal contrast-enhanced CT is performed because of a high suspicion of intra-abdominal pathology (Figures 1-4).

Figure 1.

Figure 2.

Figure 3.

Figure 4.


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