ABSTRACT
History A 21-year-old female student is sent to A&E by the out-of-hours GP. She describes 4 days of abdominal pain and diarrhoea. The abdominal pain is generalized, but worse in the right iliac fossa. It does not radiate and is relieved by lying still. She is having up to ten episodes of diarrhoea a day, which sometimes contains blood. She is not vomiting and has had a reduced appetite for 1 week. She reports weight loss of about 5 kg over the last year without dieting. She also reports intermittent episodes of diarrhoea and abdominal pain over the last two years which her GP has treated as irritable bowel syndrome (IBS). In the last two months, she also reports intermittent abdominal distension and ‘squeezing’ pain, sometimes associated with vomiting. Her past medical history includes IBS, asthma and anxiety. Regular medicines are peppermint oil capsules, mebeverine, citalopram 10mg per day and a salbutamol inhaler. She has no allergies, smokes 5-10 cigarettes a day and drinks 10 units of alcohol at weekends.
