BOF: 12
A 63-year-old male presents
with a history of diarrhoea of a months duration. The motions are pale, bulky
and foul smelling and he says they are difficult to flush away. There is no
blood or mucous in the stools he has lost weight and feels tired. No history
of fever. He relates the onset of the illness to a holiday in Eastern Europe
There is no history of
significant disease in the past. He does not drink or smoke.
Clinically he looks like he has
lost weight but there are no other abnormalities.
In this patient which one of
the following tests would be likely to lead to a diagnosis?
a) CT scan of
the abdomen
b) Faecal
elastase
c)
Colonoscopy
d) Barium
follow though
e) OGD with
distal duodenal biopsy
Answer: e)
The history suggests the
patient has malabsorption. This could be due to pancreatic insufficiency but
there is nothing on history to suggest chronic pancreatitis. Bowel cancer can
cause a change in bowel habit and in a patient in this age group it is
something that one should consider but the short duration, nature of the
diarrhoea and rapid loss of weight are against this.
This leaves small bowel
pathology, which would be diagnosed by performing an OGD and distal duodenal
biopsy. With a short duration and history of travel as a clue giardiasis is
the likely diagnosis.
Revision Tip
Revise causes of diarrhoea
ACES for PACES page 287-288
