Irritable Bowel Syndrome

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of ‍abdominal painchanges in bowel habitsdiarrheaconstipation

Symptoms include:

‍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

‍mucus in the stool

‍fatigue

‍unexplained weight loss, ‍ ‍lbskg over ‍ ‍weeksmonths

‍poor appetite

‍nausea

‍vomiting, ‍ episodes ‍per day, ‍, ‍hematemesis



Worsening factors: ‍noneeating

Alleviating factors: ‍nonedietary modifications, ‍effectiveineffective



Contributing factors:

‍high stress lifestyle

no history of: ‍abdominal surgeries, ‍food intolerance

no family history of: ‍colorectal cancer





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

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

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Anorectal: DRE ‍normal, prostate ‍normal, ‍blood, ‍mass, anus ‍

Pelvic: external genitalia ‍normal, vagina ‍normal, cervix ‍normal, uterus ‍normal, adnexa ‍normal, ‍cervical motion tenderness

Genital: penis ‍normal, testes and epididymis ‍normal, ‍inguinal hernia





ASSESSMENT:

‍Irritable Bowel Syndrome ‍likelysuspectedpossible

DDx: irritable bowel disease, functional GI symptoms, lactose intolerance, celiac disease, food intolerances, psychological stressors, inflammatory bowel disease, gastroenteritis, small intestinal bacterial overgrowth, thyroid dysfunction, colorectal cancer, endometriosis, chronic functional constipation, chronic functional diarrhea, GERD, peptic ulcer disease, gallbladder disease, pancreatic insufficiency





PLAN:

Investigations:

- 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

Treatments:

- Psychoeducation about irritable bowel syndrome

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

- Regular exercise

- Stress management techniques

- Sleep hygiene

- ‍IBS medications

Further care:

- 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