intestinal disorders/colitis

Lab Parameter	Value	Reference Range
White Blood Cell Count	22.5 x 10^9/L	4.5-11.0 x 10^9/L
Hemoglobin	135 g/L	130-170 g/L
Platelets	250 x 10^9/L	150-450 x 10^9/L
Sodium	130 mmol/L	135-145 mmol/L
Potassium	2.8 mmol/L	3.5-5.0 mmol/L
Creatinine	150 µmol/L	60-110 µmol/L
Albumin	25 g/L	35-50 g/L
Stool toxin assay for Clostridium difficile	Positive	Negative

Lab Parameter

Value

Reference Range

White Blood Cell Count

22.5 x 10^9/L

4.5-11.0 x 10^9/L

Hemoglobin

135 g/L

130-170 g/L

Platelets

250 x 10^9/L

150-450 x 10^9/L

Sodium

130 mmol/L

135-145 mmol/L

Potassium

2.8 mmol/L

3.5-5.0 mmol/L

Creatinine

150 µmol/L

60-110 µmol/L

Albumin

25 g/L

35-50 g/L

Stool toxin assay for Clostridium difficile

Positive

Negative

See Explanation

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Question 2 / 2

683ba1e631242d93219d2e9a

Gastroenterology

intestinal disorders

colitis

Case History

A 68-year-old man, admitted to the internal medicine ward for community-acquired pneumonia, develops increasing abdominal distension and diffuse abdominal pain on day 5 of hospitalization. He has been receiving intravenous piperacillin-tazobactam since admission. He reports 8-10 episodes of watery, non-bloody diarrhea daily for the past 48 hours. His medical history includes type 2 diabetes mellitus and coronary artery disease. He initially had a low-grade fever, but his temperature has now spiked to 38.8 C (101.8 F). On physical examination, he appears fatigued and pale. His abdomen is distended and moderately tender to palpation diffusely, with some voluntary guarding but no rebound tenderness. Bowel sounds are diminished. Mucous membranes are dry. Vital signs are: Temperature 38.8 C (101.8 F), blood pressure 115/70 mm Hg, pulse 98/min, and respirations 18/min. Given this patient's clinical presentation, what is the most likely diagnosis and the immediate critical diagnostic step required to assess for severe complications?

Lab Parameter	Value	Reference Range
Hemoglobin	135 g/L	130-170 g/L
Platelets	380,000/µL	150,000-450,000/µL
Leukocytes	22,000/µL	4,000-11,000/µL
Sodium	140 mmol/L	135-145 mmol/L
Potassium	3.4 mmol/L	3.5-5.0 mmol/L
Chloride	102 mmol/L	98-106 mmol/L
Bicarbonate	20 mmol/L	24-30 mmol/L
Blood Urea Nitrogen	9 mmol/L	2.5-8.0 mmol/L
Creatinine	110 µmol/L	50-90 µmol/L
C-reactive protein	150 mg/L	<5 mg/L
Serum Lactate	2.8 mmol/L	0.5-2.2 mmol/L

A ) Acute viral gastroenteritis and symptomatic management with loperamide

B ) Ischemic colitis and immediate colonoscopy

C ) Clostridioides difficile infection and abdominal CT scan to assess for toxic megacolon or perforation

D ) Drug-induced colitis and discontinuation of current antibiotics with electrolyte repletion

E ) Inflammatory Bowel Disease exacerbation and initiation of corticosteroids

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