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 Best of Five 202

 

   

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BOF: 202

A 30-year-old male presents with diarrhoea with passage of blood and mucous. The diarrhoea has been a feature for approximately 8 weeks but has increased over the last week. At present he is going to the toilet > 10 times a day, passing a lot of blood and mucous. On examination he looks unwell, has decreased skin elasticity, a pulse rate of 110 beats per minute. Abdomen mildly distended, diffuse tenderness, bowel sounds normal. Stool culture performed by his GP prior to admission has not revealed any pathogens. Unprepared sigmoidoscopy shows an erythematous, granular mucosa with multiple small ulcers and contact bleeding.

In this patient the factors determining severity of the attack are:

a)      Stool frequency > 6 /day with blood, fever > 37.5 C, Tachycardia >90 /minute, ESR 30 mm in 1st hour, Anaemia <10g/dL, Albumin < 30 g/L

b)      Stool frequency > 6 /day with blood, fever > 37.5 C, Tachycardia >90 /minute, AXR showing thumb printing, Anaemia <10g/dL, Albumin < 30 g/L

c)      Stool frequency  > 6 /day with blood, blood urea > 10 mmol/L, Anaemia <10g/dL, Albumin < 30 g/L, fever > 37.5 C, Tachycardia >90 /minute

d)      Stool frequency > 6 /day, with blood fever > 37.5 C, Tachycardia >90 /minute AXR showing dilatation of the colon, Anaemia <10g/dL, Albumin < 30 g/L

e)      Stool frequency  > 6 /day with blood, ESR .30 mm in 1st hour, Anaemia <10g/dL, Albumin < 30 g/L, blood urea > 10 mmol/L, AXR showing thumb printing

 

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