QuestionSBA
QuestionChoice
*Clostridium difficile* (CDI) is a gram-positive bacteria that can cause pseudomembranous colitis, commonly seen in patients who have recently been on a course of broad-spectrum antibiotics as likely in this case. Other risk factors include hospital stays and being over 65 years of age- both of which are present in this case too. Three of the most common symptoms are watery diarrhoea (which can be bloody), painful abdominal cramps and nausea.
10005311
a
*Clostridium difficile* infection
QuestionChoice
This is a diagnosis which more commonly causes constipation. Classically, acute appendicitis presents as progressive peri-umbilical pain that moves to the right iliac fossa. Nausea and one to two episodes of vomiting are also common and not present in this case.
10005314
d
Acute appendicitis
QuestionChoice
Symptoms of IBS are abdominal discomfort or pain that is relieved by defecation or associated with altered bowel frequency or stool form which is present here. However, the diagnostic criteria is of these symptoms and at least two of: altered stool passage (e.g. straining or urgency), abdominal bloating, symptoms made worse by eating or passage of mucous. Two of these are not present in this case.
10005313
c
Irritable bowel syndrome (IBS)
QuestionChoice
Symptoms of ulcerative colitis are classically diarrhoea containing blood or mucous, tenesmus or urgency and pain in the left iliac fossa. There is often associated weight loss and/or fever. The case described in this question is not in keeping with these.
10005312
b
Ulcerative colitis
QuestionChoice
This can present with abdominal pain. However, the most common features are abdominal bloating and vomiting (bilious often), which are not mentioned here. They may also experience a failure to pass flatus or stool, rather than loose stool.
10005315
e
Small bowel obstruction
Concept
Chapter
2693
3935
Clostridium difficile
Topic
136
Gastroenterology
13609
A 78-year-old male presents to his GP. He was recently discharged from hospital for treatment of community-acquired pneumonia. He now complains of six to eight episodes of watery stool per day with some non-specific central abdominal cramps. His bloods reveal a white cell count of 13.5 x 10<sup>9</sup>/L (4.5 - 11).

Which of the following is the most likely diagnosis?
a