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The young patient with acute bloody diarrhoea
1ST5 Geriatric and General Medicine, Calderdale and Huddersfield NHS Foundation Trust.
Insights
Young patients with acute bloody diarrhoea require prompt diagnosis to differentiate infectious colitis from inflammatory bowel disease (IBD). Early management with steroids and supportive care is crucial, with surgical intervention considered if initial therapies fail.
Area of Science:
- Gastroenterology
- Internal Medicine
Background:
- Acute bloody diarrhoea is a common presentation in acute medical units, particularly in young patients.
- Differential diagnoses include infectious colitis and new-onset inflammatory bowel disease (IBD).
Observation:
- Diagnosis requires a comprehensive approach involving clinical, laboratory, radiological, endoscopic, and histological investigations.
- Patients suspected of IBD need admission to specialist gastroenterology wards with multidisciplinary team input.
Findings:
- Intravenous steroid therapy should be initiated early for acute severe disease, preceding stool culture results unless amoebiasis is strongly suspected.
- Thromboprophylaxis, fluid balance, nutritional support, and daily clinical review are essential components of patient management.
- The Travis criteria can guide surgical risk assessment on day 3, informing rescue therapy decisions between days 3-7 for non-responders.
Implications:
- Timely and accurate diagnosis of acute bloody diarrhoea in young patients is critical for appropriate management.
- Multidisciplinary care and early initiation of evidence-based therapies can improve outcomes for IBD patients.
- Structured assessment and timely intervention planning are key to managing severe cases and avoiding complications.
Abstract:
Acute bloody diarrhoea may be commonly encountered in the acute medical unit. Among young patients, the main differential diagnoses are acute infectious colitis, and first presentation of inflammatory bowel disease (IBD). A combination of clinical, laboratory, radiological, endoscopic and histological investigations are required to make the diagnosis. If inflammatory bowel disease is suspected, then the patient should be admitted to a specialist gastroenterology ward and receive input from the surgical team, IBD nurses and specialist stoma nurses. Intravenous steroid therapy for acute severe disease should be started before stool cultures are back unless there is a strong clinical suspicion of amoebiasis. All patients require thromboprophylaxis and close attention paid to fluid balance and nutritional requirements. Daily clinical review is required. The Travis criteria may be employed at day 3 to assess the likelihood of requiring surgery and plans for rescue therapy, medical or surgical should be made between day 3-7 if the patient is not responding adequately to initial medical therapy.
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