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History of Present Illness The patient was apparently well until one month ago, when he developed a gradual onset of loss of appetite associated with intermittent vomiting. The vomiting occurred in 1–2 episodes on alternate days, was non-projectile, and contained food particles (modify if different). Following this, he developed severe abdominal pain. The pain was gradual in onset and has persisted since then (add the site, character, radiation, severity, aggravating and relieving factors if known). A few days later, the patient noticed yellowish discoloration of the urine, which progressively became darker. Subsequently, he developed yellowish discoloration of the sclera and later of the palms, suggestive of progressive jaundice. During the course of the illness, he developed an episode of loose stools with blood one month ago, occurring 2–3 times in a day. Today, he again developed diarrhea associated with blood in the stools. He also reports that his urine is now red in color. The patient therefore presents with a one-month history of anorexia, intermittent vomiting, severe abdominal pain, progressive jaundice, recurrent bloody diarrhea, and red-colored urine. Write case presentation

Here is a structured case presentation based on the history provided:

Case Presentation

Patient: [Name] | [Age] | [Sex] | [Occupation] | [Address]

Chief Complaints

  1. Loss of appetite - 1 month
  2. Intermittent vomiting - 1 month
  3. Severe abdominal pain - 1 month
  4. Progressive yellowish discoloration of sclera and skin - less than 1 month
  5. Recurrent bloody diarrhea - 1 month (recurred today)
  6. Red-colored urine - today

History of Present Illness

Mr. [Name], a [age]-year-old [male/female], was apparently well until one month ago, when he first developed loss of appetite of gradual onset. This was associated with intermittent, non-projectile vomiting, occurring in 1-2 episodes on alternate days, containing food particles, with no bile or blood noted.
Shortly thereafter, he developed severe abdominal pain of gradual onset, which has been persistent since then. [Site, character, radiation, severity, aggravating and relieving factors to be added once available.]
A few days into the illness, the patient noticed darkening of the urine, which was progressive in nature. This was followed by the appearance of yellowish discoloration of the sclera and subsequently the palms, indicating progressive jaundice. There was no associated pruritus, pale stools, or fever reported at this time. [Add if present or absent.]
Concurrently, approximately one month ago, he experienced an episode of loose stools mixed with blood, occurring 2-3 times per day. This resolved but has recurred today. On the same day, the patient also noticed that his urine has turned red in color, raising concern for hematuria or hemoglobinuria.
The patient therefore presents with a one-month history of:
  • Anorexia
  • Intermittent non-projectile vomiting
  • Severe abdominal pain [details pending]
  • Progressive jaundice (dark urine → scleral icterus → palmar yellowing)
  • Recurrent bloody diarrhea
  • Acute onset red-colored urine

Pertinent Positives and Negatives (to be completed on review)

SystemPositivesNegatives (to confirm)
GIAnorexia, vomiting, abdominal pain, bloody diarrheaFever, weight loss, tenesmus, mucus in stool
HepatobiliaryProgressive jaundice, dark urinePruritus, pale/clay-colored stools, hepatic encephalopathy
UrinaryRed urineDysuria, frequency, flank pain
General-Night sweats, travel history, sick contacts

Synthesis and Working Differential

This presentation - combining progressive jaundice, abdominal pain, anorexia, bloody diarrhea, and now red urine - suggests a systemic process rather than isolated organ disease. Key differentials to consider include:
  1. Enteric fever with hepatitis (Salmonella typhi) - common in endemic regions; can cause hepatosplenomegaly, GI bleeding, and jaundice
  2. Leptospirosis - classic triad of jaundice, renal involvement (red urine/hematuria), and GI symptoms; Weil's disease presentation
  3. Viral hepatitis (A, E) with GI involvement - hepatitis A/E can cause jaundice and bloody diarrhea in acute phase
  4. Hemolytic anemia (e.g., G6PD deficiency, malaria) - hemolysis explains jaundice + hemoglobinuria (red urine) + GI symptoms
  5. Malaria (Plasmodium falciparum) - blackwater fever can produce hemoglobinuria, jaundice, and GI symptoms
  6. Cholangiocarcinoma or pancreatic malignancy - obstructive jaundice + abdominal pain in an older patient

Points Requiring Clarification

  • Exact site, character, and radiation of abdominal pain
  • Travel history, animal/water exposure (leptospirosis risk)
  • Fever or rigors at any point
  • Weight loss quantification
  • Drug history, alcohol use, herbal remedy use
  • Family history of hemolytic disorders or liver disease
  • Vaccination history (Hepatitis A/B)
  • Whether stools became pale/clay-colored at any point
  • Occupational exposure
[Proceed to Past Medical History, Family History, Social History, Systemic Review, Examination Findings, and Investigations as appropriate.]
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