A 78-year-old man has a 10-day history of low-grade fever and diarrhea with as many as six bowel movements daily. He also has nocturnal diarrhea and develops abdominal pain before defecating. The patient has congestive heart failure. Current medications are enalapril, furosemide, and atenolol.
On physical examination, temperature is 38.2 °C (100.8 °F), pulse rate is 90/min, and blood pressure is 110/70 mm Hg. Diffuse abdominal tenderness is present. Rectal examination is normal; there is no stool in the rectal vault.
Hemoglobin: 17 g/dL (170 g/L)
Leukocyte count: 12,000/µL (12 × 109/L)
Platelet count: 380,000/µL (380 × 109/L)
Stool cultures: No growth of pathogens
Stool assay for Entamoeba histolytica antigen Negative
In addition to volume resuscitation with intravenous fluids, which of the following is the most appropriate next step in managing this patient?
a. Stool examination for fecal leukocytes
b. Stool examination for ova and parasites
c. 48-Hour fecal fat determination
d. Upper endoscopy with duodenal aspirates
e. Flexible sigmoidoscopy with biopsies
Which is most likely Diagnosis:
a. Acute diverticulitis
b. Irritable bowel syndrome
c. Inflammatory bowel disease
e. Shigellosis or Salmonellosis
Case Submitted by Dr Ibrahim Al-Mahdi ( 1, 2 )
for each alternative that you choose its better to explain, one case will have 2 winners