DIFFERENTIAL DIAGNOSIS

1. Gastroenteritis

2. infectious diarrhea- due to viral, bacteria, parasite

3. drug induced diarrhea- laxatives

4. food poisoning

5. food allergy- lactose intolerance

6. indigest of heavy metal- Cu, Zn

7. fat malabsorption

8. IBD

9. Celiac disease

10. colorectal carcinoma

• Vascular- bowel ischemia(due to eg: AF)

• infection: infectious diarrhea- due to viral, bacteria, parasite

• neoplasm- cancer/tumor

FURTHER QUESTIONING

1. HOPI- SOCRATES

   • when start?

   • duration

   • frequency

   • characteristic of stool

   • associated symptom; nausea, vomiting, weight loss, abdominal pain

   • take any medication to relieved?

   • severity: fluid loss

2. PMH

   • Take any drug

   • previous surgery

   • medical condition

   • any allergy

3. Family History

   • cancer

   • any family member have same symptom

4. Social history

   • smoking, alcohol

   • diet n food habits

   • lifestyle

   • travel history

   • occupation

nauseated = unpleasant sensation that you might vomit

diarrhoea

started about 2 days ago.

The first symptom the patient noted was loss of appetite while eating breakfast.

became nauseated and

diaphoretic.

low-grade fever

abdominal cramping and then soon after had an episode of vomiting.

Over the next 24 hours, diarrhoea developed with 5 bowel movements

during that time.

He describes the stool being watery and brown without any blood.

no medical problems and takes no medications or supplements.

has had no recent changes in his diet.

and he has eaten only food

prepared at home for the last week.

He works as a bus driver

and has

not travelled out of the country

reports no known sick contacts.

Allergies and medications

No history of allergies to food or medicines.

He is not a smoker and does not drink alcohol

The first symptom the patient noted was loss of appetite while eating breakfast=

became nauseated and diaphoretic=stress , anxiety

low-grade fever=shows he has infection / inflammation

abdominal cramping and then soon after had an episode of vomiting.

Over the next 24 hours, diarrhoea developed with 5 bowel movements

during that time.

He describes the stool being watery and brown without any blood=low possibility IBD

no medical problems and takes no medications or supplements= rule out drug induced diarrhea

has had no recent changes in his diet.

and he has eaten only food

prepared at home for the last week= food poisoning ( low possibility)

He works as a bus driver=lot of interaction with public

family history unremarkable and non smoker = less possibility for cancer

reports no known sick contacts.

Allergies and medications

No history of allergies to food or medicines.

DIFFERENTIAL DIAGNOSIS

1. Gastroenteritis

2. Celiac disease

3. IBD

4. indigest of heavy metal- Cu, Zn

   
   

General inspection

1.assessing fluid loss

2. check sign of dehydration

Physical examination

1. Vital sign= temperature , heart rate , respiratory rate , BP, oxygen saturation

2. Cardiovascular examination

3. Respiratory examination

4. Abdomen examination=bowel sound , peristalsis, acute abdomen ( surgical abdomen )

5. deep and superficial palpation = tenderness

6. percussion

7. skin turgor

hr-normal

rr-normal

bp-normal =pt is not in severe fluid loss

1.The abdomen is soft and diffusely tender on palpation with hyperactive bowel sounds on auscultation. =

2.The rectal exam shows brown, heme-negative stool. =less likely of pud,upper/lower git bleeding

hr-normal

rr-normal

bp-normal =pt is not in severe fluid loss

1.The abdomen is soft and diffusely tender on palpation with hyperactive bowel sounds on auscultation. =

2.The rectal exam shows brown, heme-negative stool. =less likely of pud,upper/lower git bleeding

DIFFERENTIAL DIAGNOSIS

1. Gastroenteritis

2. Celiac disease

3. IBD

4. indigest of heavy metal- Cu, Zn

INVESTIGATION

1.fecal occult blood test -to find hidden HB in feces

2.FBC -wbc status

-ESR

-CRP

-PCV

-Electrolytes (potassium loss during vomits)

3.creatinine- to look for acute renal failure due to severe dehydration

4.