Appearance of blood in the diarrheal stool is the main risk factor in a patient of inflammatory bowel disease as the mucosal membrane is ulcerated. According to the patent there are nocturnal bowel movements which are almost never seen in irritable bowel syndrome. Recent smoking cessation could also be an additional risk factor as cigarette is supposed to protect the mucosal membrane against ulcers. The patient has been using NSAIDs (ibuprofen) recently and the prolong use of these drugs usually causes ulcers. The patient also has a family history of ulcers which makes her genetically predisposed to the disease. On physical examination, the patient appeared slim; signs of weight loss were prominent. The oral mucosa was dry. The heart rate was increased. There was also mild tenderness in the abdomen. All the signs of inflammatory disease, including fever, were present.
Patients presenting with chronic diarrhea are usually suggested for flexible sigmoidoscopy or colonoscopy. Endoscopy is performed when these non-invasive procedures fail to give a positive result and the patient still presents with the signs of inflammation. Endoscopy has some advantage over these procedures in a way that it does not only give a complete internal view of the organ but also allows the physician to collect samples for biopsy. Colitis is graded from mild to moderate and severe on the extent of the damage to the mucosal membrane. If on endoscopic examination the loss of mucosal integrity is not so severe the colitis is termed as mild or moderate. In contrast, patients presenting with sudden onset of signs and symptoms with a greater loss of the mucosa, the disease is termed as severe colitis. Flexible sigmoidoscopy although an efficient procedure, still requires colonoscopy to be done to rule out any false positive results.
Physical examination showed dehydration which is confirmed by the electrolyte imbalance shown in the reports.