QuestionSBA
QuestionChoice
Symptoms of ulcerative colitis classically include diarrhoea. However, the stool normally contains blood or mucus. Other symptoms include 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 less in keeping with this.
10005318
c
Ulcerative colitis
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.
10005319
d
Irritable bowel syndrome (IBS)
QuestionChoice
This is a condition most commonly seen in female smokers aged between 15 and 40. The right-sided abdominal pain and extreme number of diarrhoeal episodes are also indicative of Crohn's disease.
10005316
a
Crohn's disease
QuestionChoice
Bowel obstructions would usually present more acutely than over a three-week period. Additionally, the commonest causes of large bowel obstructions are cancer, volvulus and diverticular disease which are rare in a person of this age. Inflammatory bowel disease, which is most likely in this case, may lead to a small bowel obstruction but is unlikely to cause a large bowel obstruction. Lastly, bowel obstruction would likely present with an absence of passing stool and flatulus, whereas the opposite is true in this case.
10005317
b
Large bowel obstruction
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, which is not seen in this case. Other risk factors include hospital stays and being over 65 years of age, which are both absent in this case too. CDI does cause watery diarrhoea which can be bloody. However, it is classically associated with painful abdominal cramps and/or nausea.
10005320
e
Clostridium difficile infection
Concept
Chapter
2693
4000
Crohn's disease
Topic
136
Gastroenterology
13610
A previously well 26-year-old female smoker presents to her GP. She complains of three weeks of crampy right iliac fossa abdominal pain with non-bloody diarrhoea on average 10x per day.

Which of the following is the most likely diagnosis?
a