Irritable Bowel Syndrome

HISTORY:

‍Abdominal painChanges in bowel habitsDiarrheaConstipation for ‍ ‍hoursdays

‍abdominal pain, ‍diffuse, ‍dull, ‍mild

‍bloating

‍excessive gas

‍diarrhea, ‍ episodes ‍per day, ‍

‍constipation

‍feeling of incomplete bowel movements

‍hematochezia, ‍bright reddark red, ‍around stoolsmixed with stools, ‍withwithout clots

‍melena

‍mucus in stool

‍fatigue

‍unexplained weight loss, ‍ ‍lbskg over ‍ ‍weeksmonths

‍loss of appetite

‍nausea

‍vomiting, ‍ episodes ‍per day, ‍

‍hematemesis

Worsening factors: ‍noneeating

Treatments tried: ‍nonedietary modifications, ‍effectiveineffective



EXAM:

General appearance: ‍well-appearing

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Abdomen: ‍softsemi-softtense, ‍non-tender ‍, ‍non-distended, ‍

Pelvic: vulva ‍normal, vagina ‍normal, cervix ‍normal, uterus ‍normal, adnexa ‍normal, ‍no cervical motion tenderness

Genital: ‍normal, testicles ‍normal, penis ‍normal



ASSESSMENT:

‍Irritable bowel syndrome ‍likelysuspectedpossible

DDx: ‍



PLAN:

- Blood work: ‍CBC, ‍CRP, ‍TSH, ‍ferritin, ‍vitamin B12, ‍albumin, ‍glucose, ‍LFTs, ‍lipase, ‍anti-transglutaminase

- Stools: ‍bacterial culture, ‍parasitic culture, ‍C. difficile toxin, ‍calprotectin

- Colonoscopy

- Abdominal ultrasound

- Psychoeducation about irritable bowel syndrome

- Dietary modifications: ‍FODMAP diet, ‍increase fiber intake, ‍avoid trigger foods

- Regular exercise

- Stress management techniques

- Sleep hygiene

- ‍IBS medications

- Referral to dietitian

- Referral to psychologist

- Referral to gastroenterologist

- Follow-up in ‍ ‍weeksmonths

- Return if symptoms worsen or if new symptoms develop such as weight loss, blood in stools, or fever