Physician's Assistant

Referral Wed 10 September 2025 11:33

Last Modified: 208 days ago

MRN:

Content:

Investigations:
CT scan abdomen and pelvis: No acute pathology identified, 11mm lymph node noted in right upper abdomen
Ultrasound scan: No significant abnormalities, possible small ovarian cyst
Blood tests: Potassium normal, evidence of dehydration
Stool samples: No infection detected on initial testing
Chest X-ray: Performed

Thank you for asking me to review this patient who has been admitted under your team with severe gastroenteritis.

This patient presented on Monday with acute onset vomiting which progressed to profuse watery diarrhoea (Bristol stool type 7). She reports 8 episodes since Friday night, with associated severe abdominal pain initially requiring morphine analgesia. The pain was predominantly right-sided lower abdominal, worse on movement, causing her to adopt a foetal position. She has never experienced symptoms of this severity before.

She has been taking Mounjaro (semaglutide) for 8 weeks, which can rarely cause pancreatitis. She has a previous history of pancreatitis secondary to UTI and subsequent antibiotic treatment. She denies recent travel, dietary indiscretions, or contact with unwell individuals. She does not smoke and works in sport.

On examination, she appears dehydrated with difficult venous access noted. No palpable lymphadenopathy detected.

Imaging has been reassuring with no acute surgical pathology. The 11mm lymph node in the right upper abdomen is likely reactive secondary to gastroenteritis. The small ovarian cyst is incidental and would not account for her GI symptoms.

Impression:
Severe gastroenteritis, likely infective cause despite negative initial stool cultures
Dehydration
Reactive lymphadenopathy

Suggest:
1. Repeat stool sample for comprehensive microbiology including parasites
2. Consider empirical antibiotic therapy if symptoms persist beyond typical gastroenteritis timeline
3. Continue supportive care with IV fluids as needed
4. Symptomatic relief with loperamide if appropriate (noting caution in suspected infective diarrhoea)
5. Follow-up ultrasound scan in 4-6 weeks to ensure resolution of lymph node
6. Consider temporary cessation of Mounjaro until symptoms resolve
7. Discharge when clinically stable with appropriate safety-netting advice

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Summary:

Investigations:

Referral Wed 10 September 2025 11:33

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