A 48 years old woman with Bloody Diarrhea:

 A 48 years old woman with Bloody Diarrhea:

A 48 year old lady presents to you with 48 hour history of loose stools , mainly watery in nature and sometimes mixed with blood.

She has had episodes of upto 12 motions per day.

You are asked to review the patient :

History of presenting illness :

Ask the patient what does she mean by diarrhea.

Frequency of stools :

How many times has she opened her bowels

A sudden fall in stool frequency may be suggestive of colonic dilatation and subsequent perforation.

What is the nature of diarrhoea ?

Frequent passage of small amounts iof stools is suggestive of proctitis or rectal lesion.

Large volumes indicate small bowel pathology.

Foul smelling bulky stools that are difficult to flush away are characteristic of malabsorption.

Any presence of diarrhea at night is suggestive of irritable bowel syndrome

The daily dietry intake of food and liquid combined with gastric and intrestinal secretions result in volume load of about 7 l entering the small intestine.

By the time intestinal contents have reached the terminal ileum , only 1.5 litre remains so small bowel pathology often causes large volume diarrhea.