Week 6 discussion
Diagnosing Gastrointestinal Disorders
In primary care settings, patients often present with
abdominal pain. Although this is frequently a sign of a gastrointestinal (GI)
disorder, abdominal pain could also be the result of other systemic disorders,
making this type of pain difficult to assess. While abdominal pain is most
common, many other GI symptoms also overlap multiple disorders, further
increasing the difficulty in diagnosing and treating patients. This makes
provider-patient communication essential. You must be able to formulate
questions that will prompt the patient to provide the necessary information, as
this will guide your assessment and diagnosis. For this Discussion, consider
potential diagnoses for the patients in the following case studies.
Case Study 1:
A 49-year-old man presents to the office complaining of
vague abdominal discomfort over the past few days. He states he does not feel
like eating and has not moved his bowels for the last 2 days. His patient
medical history includes an appendectomy at age 22 and borderline hypertension,
which he is trying to control with diet and exercise. He takes no medications
and has no known allergies. Positive physical exam findings include a
temperature of 99.9 degrees Fahrenheit, heart rate of 98, respiratory rate of
24, and blood pressure of 150/72. The abdominal exam reveals abdominal
distention, diminished bowel sounds, and lower left quadrant tenderness without
Case Study 2:
A 40 year-old female presents to the office with the chief
complaint of diarrhea. She has been having recurrent episodes of abdominal
pain, diarrhea, and rectal bleeding. She has lost 9 pounds in the last month.
She takes no medications, but is allergic to penicillin. She describes her life as stressful, but
manageable. The physical exam reveals a pale middle- aged female in no acute
distress. Her weight is 140 pounds (down from 154 at her last visit over a year
ago), blood pressure of 94/60 sitting and 86/50 standing, heart rate of 96 and
regular without postural changes, respiratory rate of 18, and O2 saturation
99%. Further physical examination reveals:
Skin: w/d, no acute lesions or rashes
Eyes: sclera clear, conj pale
Ears: no acute changes
Nose: no erythema or sinus tenderness
Mouth: membranes pale, some slight painful ulcerations,
right buccal mucosa, tongue beefy red, teeth good repair
Neck: supple, no thyroid enlargement or tenderness, no
Cardio: S1 S2 regular, no S3 S4 or murmur
Lungs: CTA w/o rales, wheezes, or rhonchi
Abdomen: scaphoid, BS hyperactive, generalized tenderness,
rectal +occult blood
Case Study 3:
A 52-year-old male presents to the office for a routine
physical. The review of symptoms reveals anorexia, heartburn, and weight loss
over the past 6 months. The heartburn is long standing, occurring most days
during the week. He takes TUMS or Rolaids to relieve the discomfort. The
patient describes occasional use of ibuprofen for back pain, but denies other
medications including herbals. He has no known allergies. He was adopted so
does not know his family history. Social history reveals that, although he
stopped smoking ten years ago, he smoked for 20 years. He occasionally consumes
alcohol on the weekends only. The only positive physical exam finding for this
patient was slight epigastric tenderness. The remainder of his exam was
negative and the rectal exam was negative for blood.
Review this weekâ€™s media presentations and Part 12 of the
Buttaro et al. text in the Learning Resources.
Select one of the three case studies listed above. Reflect
on the provided patient information including history and physical exams.
Think about a differential diagnosis. Consider the role the
patient history and physical exam played in diagnosis.
Reflect on potential treatment options based on your
Post on or before Day 3 an explanation of the differential
diagnosis for the patient in the case study that you selected. Describe the
role the patient history and physical exam played in the diagnosis. Then,
suggest potential treatment options based on your patient diagnosis.
Read a selection of your colleaguesâ€™ responses.
Respond on or before Day 6 to at least two of your
colleagues on two different days who selected a different case study than you
did. If you selected Case Study 1, then you would respond to a colleague who
selected Case Study 2 and another colleague who selected Case Study 3. Based on
information missing from the patient history, suggest other possible diagnoses.
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