مسنة عمرها ٨٤ سنة في دار رعاية، تأخذ مورفين لألم الورك ولا تتحرك كثيراً. صار عندها تسرب سائل بني من الشرج طوال اليوم وألم بطن وتشوش جديد. لم تُخرج براز طبيعي من ٦ أيام. الحرارة ٣٧٫٢. ما التفسير الأرجح؟

An 84-year-old care-home resident takes morphine for hip pain and is largely immobile. She now leaks brown liquid from the rectum all day, has abdominal pain and new confusion. No normal stool for 6 days. T 37.2 °C. What is the most likely explanation?

1. Late-onset ulcerative colitis
2. Faecal impaction with overflow around the mass
3. Infectious diarrhoea needing an antidiarrhoeal
4. A food allergy to something new at the home

Answer: B) Faecal impaction with overflow around the mass. In older adults, especially on opioids and immobile, impaction can cause liquid overflow mistaken for diarrhoea, with confusion. Antidiarrhoeals worsen it; perform a rectal exam and treat the impaction.