Clinical Cases

A 65-year-old man goes to his general practitioner complaining of diarrhea

A 65-year-old man goes to his general practitioner complaining of diarrhea 1 MED4MIN.com Medicine Made Easy Clinical Cases
Source MedicalNewsToday
A 65-year-old man goes to his general practitioner (GP) complaining of diarrhea. This had developed suddenly 2 days previously. His motions are watery and foul-smelling. There is no blood or mucus in the stool. There is colicky abdominal pain not relieved by defaecation. The man has a poor appetite and feels nauseated. He feels tired.

The man has recently retired and returned 2 weeks ago from a coach trip to Eastern Europe and Russia. No one else on the coach was ill during the holiday. He is otherwise well, with no significant medical history. He smokes 10 cigarettes a day and drinks two pints of beer a day. The examination is unremarkable, and the GP diagnoses ‘traveler’s diarrhea’, and prescribes loperamide. Two weeks later the patient returns to the surgery. The diarrhea has persisted and the patient has lost 6 kg in weight.

Examination

  • On examination, the patient looks well.
  • His blood pressure is 158/88 mmHg.
  • Cardiovascular, respiratory and abdominal examinations are unremarkable.

Questions

  • What is the likely diagnosis?
  • How would you further examine, investigate and manage this patient?

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