11.30am Lucia Ciabanu – Abdominal pain

Lucia Ciabanu age 69 is complaining of worsening left sided lower abdominal pain. She has also noticed her bowel habits have become more erratic over the last few months, she has had episodes of diarrhoea alternating with constipation.

She also noticed bright red blood in her stools at the end of defeacation, there is no mucus. Her left iliac fossa pain comes intermittently and mostly relieved upon defeacation.

She has also been passing a lot of flatus, there was no faecal incontinence.

She also mentioned that her haemorrhoids had become more problematic recently.

She denied any weight loss, changes in appetite, indigestion, heartburn, haematemesis or nausea/vomiting. She did not complain of urinary symptoms (e.g. dysuria, haematuria, frequency, urgency, incontinence, etc).

She had some problems with stiff joints mainly in her wrists, hands, knees and ankles, which were worse in the morning. She has a history of rheumatoid arthritis. At present, she has no joint problems as the anti-rheumatoid medications and analgesics provided symptomatic relief and remission of her RA. However, the co-codamol makes her constipated.

Differential diagnoses

  • sigmoid diverticulitis
  • leaking abdominal aortic aneurysm
  • renal colic
  • ovarian cyst
  • incarcerated hernia
  • bowel obstruction

Despite taking an excellent history from Lucia – you feel that a phone call is not sufficient to rule out red flags, you give her an appointment for this afternoon face to face. You have asked her to bring in a urine sample.