35/ M mason by occupation presented with history of bleeding per rectum -3-4 episodes / day for 2-3 days,associated with hard stools +

 This is an online E log book to discuss our patient's de-identified health data shared after taking his/ her /guardian's signed informed consent. 

Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. 

This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box is welcome.   



Chief complaints:-
35/ M who works as a  mason presented to us with history of 
1) bleeding per rectum -3-4 episodes / day for 2-3 days , associated with hard stools +
Intermittently - for 5-6 months and he Was said to have anal fissure ,used sitz bath and ointment .
No altered bowel habits at that time .

Since December - Patient complaining of - altered bowel habits ,for 10 days he passes  stools with normal  consistency and frequency then followed by hard stools for 2 days then followed by loose stools -small quantity ,associted with mucus + and blood , foul smelling stools ,2-3 episodes per day ,tenesmus + .no difficulty in flushing stools ,Relieves with fasting .These last  for one week , subsides with sitz bath and lignocaine topical application .
Then recurrs again after 10-15 days .

February - patient had 3 eipsodes of loose stools with severe pain abdomen-left iliac region ,non radiating , he was taken to local hospital ,
Usg - pancreatitis ,Gastritis .
Patient lost 5kgs   in 6 months .
 No fever ,no joint pains ,no vomitings ,no fresh bleed .
Since 5 days Patient complaints of loose stools -small quantity , tenesmus + ,with mucus and blood .no pain abdomen 

Stool sample On day 1:- 6th april,2021

Stool sample On day 2:-7th April,2021

Stool sample on day 3:- 8th April,2021

Past history:-
Pt gives h/o similar complaints in the past, 5 months ago
On 22nd December, 2020  pt went to hospital with c/o pain abdomen ,blood stained stools,a/w mucus ,increased frequency of passing stools, altered bowel habits(hard and loose stools)

On 31st Dec,2020 followup treatment was taken 
on 15th Feb,2021,patient had 3 episodes of loose  stools with severe pain abdomen-left iliac region non radiating , he was taken to local hospital and diagnosed as pancreatitis, Gastritis 
15th Feb,2021                    18th Feb,2021
15th Feb 2021                   18th Feb 2021

Not a k/c/o DM/ASTHMA/HTN/EPILEPSY/TB


Personal history:-
Consumes mixed diet,  appetite normal,
Previously ocassional alcoholic ,Stopped alcohol 5 years back.
Non smoker 

On examination:-
Pt is conscious, coherent, cooperative 
Moderately built, Moderately nourished 
No signs of pallor, icterus, cyanosis, clubbing, koilonychia, lymphadenopthy 
Temperature:-afebrile
Bp: 130/80mmhg
Pr:- 84bpm,
Cvs:- s1s2+
Rs:- BAE+
CNS:- NAD

Diagnosis - Dysentery / IBS

Treatment:-
TAB mesalazine 1.2gm /tid
Tab pan 40MG/po/od
Tab  sporolac ds/tid
Tab metronidazole 400mg/od

Guided by 
Dr Pradeep gm pg 1yr

Discussion:-
-Check out the efficacy of meselamine in ulcerative colitis and share

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