Skill Checkup: A 46-Year-Old Man With Moderate Abdominal Pain, Tenesmus, and Bloody Diarrhea

Charles Bernstein, MD


February 16, 2022

The Skill Checkup series provides a quick, case-style interactive quiz highlighting key guidelines- and evidence-based information to inform clinical practice.

A 46-year-old Canadian man from the Quebec region presents to his healthcare provider with moderate abdominal pain, tenesmus, and bloody diarrhea four to six times per day, including nocturnal bowel movements. The patient states that his symptoms began approximately 4.5 weeks ago. The patient was diagnosed with ulcerative colitis 14 months earlier after being hospitalized for symptoms including severe diarrhea more than six times a day, abdominal pain, and fever. Colonoscopy showed extensive ulcerative colitis. A 3-day course of intravenous methylprednisolone 60 mg/d successfully induced remission. Upon discharge, infliximab 5 mg was prescribed for maintenance therapy.

Physical examination reveals 1.8 kg (about 4 lb) weight loss. The patient's height and weight are 172.7 cm (about 5 ft 7 in) and 65.6 kg (144.6 lb), respectively; his BMI is 22. All vital signs are within normal range. He is a smoker (30 pack-years) but refrains from alcohol consumption. His history is notable for hypertension (stage 1). Current medications are infliximab 0.92 mg/d and lisinopril 80 mg/d.


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