Discussion
Topic 1: Abdominal Pain
Case Study 1—Abdominal Bloating and Diarrhea
Subjective
Amelia, a 25-year-old Caucasian female, presents to the primary care clinic with the chief complain of abdominal bloating and diarrhea, worsening over the past 2–3 months. This patient is generally healthy. Occasionally she comes to the clinic for an acute illness. Her last visit was almost a year ago. She had some flu-like symptoms. She goes to her gynecologist annually and considers this here routing health maintenance; her last visit was 6 months ago with no significant findings. She has a self-described long history of non-specific gastrointestinal malaise. She bloats, feels nauseous, and has inconsistent voiding patterns with a tendency to have loose stools. Over the past 2 months, however, more than 60% of her stools have been loose, which is, double the usual. She is voiding about 2 times a day, which feels frequent to her, although her elimination patter has never been consistent. Generalized abdominal bloating has been increasing in frequency and intensity, now occurring 4–5 times per week, generally 1 hour after eating. There is associated generalized cramping and pain that she rates a 6/10, though she has not pain right now. She has vomited 3 times without any resolution of symptoms. The patient denies making herself vomit. She reports that she had to leave work numerous times because of the pain and discomfort. Lying down and applying heat makes her symptoms more tolerable; but this is an unsustainable management technique; and she is worried and frustrated. She has not done any recent traveling.
Past medical history: Allergic rhinitis
Family history: Mother and father are alive and well, both with hypertension. Brother, 20, is alive and well with type 1 DM, which he manages well.
Social history: She is a college graduate currently working 50 hours per week for a community development nonprofit organization. She loves her job and sleeps well-though admittedly not enough- usually 6 or 7 hours per night. She goes to the gym for an hour 3–4 times per week, has an active social life, is applying for graduate school, and is generally pleased with her life. If she could change anything, “I would add a couple of hours to the day so I could slow down a little and still get things done. I am pretty type A, which is why this stomach thing is bothering me so much.” She drinks 2-3 cups of coffee a day; skips breakfast; eats a bagel, yogurt, and fruit for lunch; usually goes out or eats “healthy” takeout dinner. She drinks socially about 1 time per week. Denies any tobacco or other drug use.
Medications: Yaz, daily (birth control) multivitamin daily; OTC Claritin, 1 tab PRN for allergy symptoms; OTC Mucinex, PRN for cold symptoms
Allergies: Seasonal. NKDA or NKFA
Screening: Routing blood work last year WNL, but showed borderline iron deficient anemia. Negative Pap test last year.
OBJECTIVE
General: Well developed and well nourished, 25-year-old female who looks her stated age. She is in no acute distress.
Skin: Clear
HEENT: Unremarkable
Neck: No lymphadenopathy
Respiratory: Chest clear to auscultation (CTA)
Cardiac: RRR, without murmurs rubs or gallops
Abdominal: Symmetrical, soft, non-tender, non-distended, no organomegaly. Positive bowel sounds in all four quadrants.
- List 3 differential diagnoses (rule in or out according to history, exam, or lab work).
- Create a treatment plan for this patient.
