Bloody Diarrhea

Pertinent positives/negatives:

_ assoc with significant abd pain

_ hx of inflammatory bowel FH

_ changes in diet

_ recent travel/camping

_ sick contacts (w/ similar sx)

_ anemic sx

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Complaint specific findings on exam:

_ normal exam of anus (no fissures, identifiable sources of bleeding)

_ benign abd exam (serially on initial presentation and upon disposition from ED)

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ED COURSE:

_ Diagnostically

_ Hg POC

MDM (with A/P):

_

presentation is most consistent with

 _

Plan _

DDx (I considered that there is a small but finite risk for the following processes. The patient’s presentation does NOT meet our criteria for being reasonable for additional pursuit of these entities at this time (i.e. reasonable level of consistency with characteristic findings as detailed parenthetically below):

-Intra-addominal pathology including intesusspection, obstruction,  given pt’s presentation NOT reasonably consistent w/ sufficient associated characteristics, i.e.

( significant abd pain, non-benign serial abdominal exams)

-Auto-immune colitis 

     _ given pt well appearing, will have parents follow up promptly with PMD for evaluation of potential offending agent

     _ given pt toxic appearing, admitting for inpatient evaluation, GI evaluation

– Given bloody stool and concern for infectious etiology, will send stool studies: (SSYCE and OP)

• • salmonella

  • shigella

  • yersinia

  • campylobacter

  • enterohemorrhagic coli

  • ova and parasite

_ C. Dif positive:

          1st bout: plan: treat with flagyl

          2nd bout: plan: treat with flagyl

          3rd bout: plan: treat with vanc