Case study 1
For the first case study, we are dealing with a case involving a 49-year-old male. He is complaining of abdominal pain with some constipation for the past two days. He does not feel like eating because he had not had any bowel movement in the last two days. Medical history indicates that he had the appendectomy surgery at the age of two and has also been diagnosed with borderline hypertension that is controlling by exercising and diet. Currently, he is not on any medication but recently took brufen to calm down his stomach pains. The positive physical exam shows that he has a high temperature of 99.9 oF respiratory rate of 24, heart rate is high by 98, and his blood pressure is 150/72. Abdominal exam shows diminished bowel sounds, abdominal distention and tenderness on the lower left quadrant with no rebound.
The patient is an accountant by profession. He feels no headaches, no chest pains, no difficulty swallowing, and no neck pains. His family has no history of abdominal pains or cancer. He has no chest pains has never had a history of bowel problem (Buttaro, et al., 2013).
Diagnosis
The condition that the patient is most likely suffering from is irritable bowel syndrome (IBS). This condition is characterized by adnominal pain or discomfort and at least other symptoms such as changes in stool consistency, change in stool frequency and relief through defecation (Drugs.com n.d). For the case study, the patient is having abdominal discomfort and constipation which is an indication of a slower rate of colonic transit. The cause of the condition ranges from the physiologic factors such as visceral hyperalgesia, motility and various environmental and genetic factors. with the presence of constipation the [patient is most likely to be having fewer rate of colonic contractions of high amplitude propagation and this propels the colonic contents to move over various segments.. Also the activity of excess sigmoid motor can contribute to retarding transit for functional constipation. The presence of fever is another red flag for IBS.
Differential diagnosis
Due to the fact that IBS patients can develop organic conditions, tests have to be considered in patients with alarm symptoms. Other illnesses that can easily be confused with IBS are Drug-induced diarrhea (this is not the case since the patient is not on medication and he has no diarrhea). It can also be a case of lactose intolerance, abuse of laxative, postcholecystectomy syndrome, parasitic diseases, like giardiasis, Microscopic colitis, and bacterial growth in small bowel, celiac diseases, microscopic colitis, enteritis or celiac diseases. It can also be confused with the early signs indicating inflammatory bowel disease (National Digestive Diseases Information Clearinghouse, n.d).
The patient history was vital in knowing if the patient has had repeated cases of abdominal problems. We also get to understand that the problem is having is not a genetic condition since none of his family members have abdominal problems. Additionally patient history lets us know that the abdominal problem is not caused by food poisoning or allergic reactions to medications. Thus this information helps in guiding the clinician with diagnosis. Also the physical examination provides data that also guides in diagnosis. We learn that the patient has fever. He also has exam shows diminished bowel sounds abdominal distention and tenderness on the lower left quadrant with no rebound and has high temperature which are symptoms of IBS.
Potential treatment options
Patient has to avoid foods that are hard or take long to digests; he should take high fiber foods to avoid constipation. He should take psyllium hydrophilic mucilloid and two glasses of water to improve digestion. Other drugs are the chloride channel activator and uanylate cyclase C agonist taken once a day. Polyethylene glycol laxatives have also been found to reduce constipation though not tested (Institute for Safe Medication Practices, n.d.).
References
Buttaro, T, Trybulski, J. & Sandberg-Cook, J (2013). Primary carecollaborative practice St. Louis, MO: Mosby.
Drugs.com. (n.d.). Retrieved from www.drugs.com
National Digestive Diseases Information Clearinghouse. (n.d.).
Institute for Safe Medication Practices. (n.d.).
Sherry Roberts is the author of this paper. A senior editor at Melda Research in nursing paper writing services if you need a similar paper you can place your order for medical essay writing service online.
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