Case 5: Differential Diagnosis

Try again! Nausea, anorexia, abdominal pain, and fever are all seen with appendicitis, however the abdominal pain is classically located periumbilically or in the right-lower quadrant. This patient’s left lower quadrant pain makes this diagnosis less likely.

Good choice! Infection (including viral, bacterial, Clostridium difficile) is the most common cause of acute diarrhea (duration <14 days) in adults. The presence of a low grade fever and crampy abdominal pain in this patient might further raise your suspicion for this diagnosis. A good history can help to differentiate between small bowel infection (watery diarrhea, abdominal cramping, bloating, watery diarrhea) and large bowel infection (fever, mucoid or bloody diarrhea.

Try again! While obstruction is a good thought for an older patient with abdominal pain and nausea, bowel obstructions typically present with obstipation. The presence of diarrhea and lack of surgical history in this patient makes this diagnosis less likely. 

Good choice! The presence of left lower quadrant pain and tenderness to palpation combined with this patient’s acute presentation places this diagnosis high on your differential.

Less likely. Although this patient has features of chronic bloating and diarrhea, given the acute onset of his abdominal pain and associated fevers and weight loss, alternative etiology for his acute presentation must be considered. Try again!

Good choice! Acute onset abdominal pain in an older adult with multiple risk factors for ischemia (age, HTN, smoker), should always raise your concern for ischemic colitis. Bloody diarrhea would have increased the likelihood for this diagnosis.

Try again! IBD typically presents with a more chronic course. The acuity of this patient’s current episode makes a diagnosis of IBD less likely.

Correct! This diagnosis should certainly be on your differential for an older patient presenting with bowel habit changes. The most common symptoms of CRC include hematochezia, abdominal pain, iron deficiency anemia, and changes in bowel habits.