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‘A 45 years old lady presented with bloody diarrhoea & multiple joint pain (Salient feature)
1. WELCOME TO GRAND ROUND
PRESENTATION
Speaker:
Dr. Farhana Faruque
Indoor Medical Officer,
Medicine Unit – 2, SSMC & MH
2. ‘A 45 years old lady presented with
bloody diarrhoea & multiple joint pain.’
3. Salient Feature:
Mrs. Rokeya Begum,45 years old, female,muslim
normotensive, non diabetic, non smoker,
housewife, hailing from Motlob, Chadpur,
admitted in this hospital with the complaints of
frequent loose motion with blood for 15 years,
abdominal pain for 15 years, pain & swelling in
multiple joints of hands & feet for 13 years.
4. Salient Feature(contd.)
According to the statement of the
patient, from last 15 years, she has been
suffering from frequent loose motion
mixed with blood & mucus, 3-4 times
daily, not related to any food or drug but
sometimes tenesmus is present.
5. Salient feature(contd.)
She has abdominal pain which is colicky in nature,
occurs diffusely, mild to moderate intensity,
persists for minutes to few hours, not related to
food & usually relieved by defecation. She has also
multiple joint pain & swelling of both hands &
feet. Joints are involved bilaterally, symmetrical.
6. Salient feature(contd.):
Later bilateral knee & elbow joints are
involved. Gradually pain has become severe
& she can’t perform her daily activities
easily. Pain is associated with morning
stiffness, that persists more than one hour
& relieved by activity.
7. Salient feature(contd.):
She has loss of appetite & loses about 10 kg
weight during this period. She has also
history of mouth ulcer & leg ulcer about 11
years back, which was healed over the next
three years. She has no history of any
perianal pain, eye problem,fever, cough,
8. Salient feature(contd.):
Breathlessness, skin rash, photosensitivity.
She has history of hospitalization for two
times & seven unit blood transfusion for the
last 15 years. She is on Irregular medication
with Sulfasalazine, Prednisolone &
Omeprazole.
9. Salient feature(contd.):
On examination, patient is mildly anaemic,
non icteric, pulse-88beats/min, BP-110/70
mmHg, multiple scar marks are present in
both legs. Deformity present in hands & feet.
All other vital parameters are normal.
10. Salient Feature(contd.)
Wrist joints are swollen, PIP of both hands
are spindle shaped. Boutonniere deformity
present both right & left little & ring
fingers. Z deformity present in right thumb.
Wasting of thenar & hypothenar muscle with
dorsal guttering of both hand present.
11. Salient Feature(contd.)
All the joints of both hands are tender.
Movement is restricted in both wrists &
fingers. All the MTP joints & IP joints are
swollen & deformed in both feet.
Lateral deviation with dorsal subluxation
of toes with valgus deformity present.
12. Salient Feature(contd.)
Both the knee & elbow joints are swollen
& tender.
Breath sound is vesicular without added
sound. All jerks are present and vibration
sense is intact. There is no conjunctivitis,
nodules, splenomegaly, perianal skin tags,
fissure or fistula.
21. Urine R/M/E (03/05/2018):
Physical Examination:
Colour Straw
Turbidity Clear
Sediment Nil
Specific gravity 1015
Chemical Examination:
PH 5.0
Albumin Trace
Sugar Nil
Phosphate Nil
Ketones Not done
Bile salt Not done
Bile pigments Not done
Urobilinogen Absent
24. Investigations:
Colonoscopy (29/04/2018):
Seen upto terminal ileum.
All mucosa of rectum & whole colon
shows superficial ulceration with
contact bleeding, friability,
granularity. The normal vascular
pattern is lost.
27. Investigations:
Histopathology of Rectal tissue (30/04/2018):
Microscopic appearance:
Serial sections show rectal tissue. The
lamina propria has been infiltrated by
moderate number of chronic inflammatory
cells.
28. Investigations:
Histopathology of Rectal tissue (30/04/2018):
Microscopic appearance:
No granuloma or evidence of malignancy is seen.
Diagnosis: Rectal tissue: Chronic proctitis
