Constipation/Diarrhea Flashcards
What key history would you obtain from a patient who complained of constipation or diarrhea?
Frequency and volume of stools Duration of change in bowel habits Associated symptoms (constitutional, abdominal pain, bloating, sense of incomplete evacuation, melena or hematochezia) Thyroid disease symptoms Die (especially fiber and fluid intake) Medications (including recent antibiotics) Sick contacts Travel Camping HIV risk factors History of abdominal surgeries Diabetes Pancreatitis Alcohol and drug use Family history of colon cancer
What key physical exams would you perform on a patient who complained of constipation or diarrhea?
Vital signs
Relevant thyroid/endocrine exam
Abdominal and rectal exams
Female - pelvic exam
67 yo M presents with alternating diarrhea and constipation, decreased stool caliber and blood in the stool for the past eight months. He also reports unintentional weight loss. He is on a low-fiber diet and has a family history of colon cancer. Differentials?
Colon cancer Irritable bowel syndrome Diverticulosis GI parasitic infection (ascariasis, giardiasis) Inflammatory bowel disease Angiodysplasia
67 yo M presents with alternating diarrhea and constipation, decreased stool caliber and blood in the stool for the past eight months. He also reports unintentional weight loss. He is on a low-fiber diet and has a family history of colon cancer. Differentials: colon cancer, irritable bowel syndrome, diverticulosis, GI parasitic infection (ascariasis, giardiasis), inflammatory bowel disease, angiodysplasia. Workup?
Rectal exam CBC AST/ALT/bilirubin/alkaline phosphatase Colonoscopy Barium enema CT - abdomen/pelvis
28 yo M presents with constipation for the last three weeks. Since his mother died two months ago, he and his father have eaten only junk food. Differentials?
Low-fiber diet Irritable bowel syndrome Substance abuse (e.g. heroin) Depression Hypothyroidism
28 yo M presents with constipation for the last three weeks. Since his mother died two months ago, he and his father have eaten only junk food. Differentials: low-fiber diet, irritable bowel syndrome, substance abuse (e.g. heroin), depression, hypothyroidism. Workup?
Rectal exam
TSH
Electrolytes
Urine toxicology
30 yo F presents with alternating constipation and diarrhea and abdominal pain that is relieved with defecation. She has no nausea, vomiting, weight loss or blood in her stool. Differentials?
Irritable bowel syndrome Inflammatory bowel disease Celiac disease Chronic pancreatitis GI parasitic infection (ascariasis, giardiasis) Lactose intolerance
30 yo F presents with alternating constipation and diarrhea and abdominal pain that is relieved with defecation. She has no nausea, vomiting, weight loss or blood in her stool. Differentials: irritable bowel syndrome, inflammatory bowel disease, celiac disease, chronic pancreatitis, GI parastitic infection (ascariasis, giardiasis), lactose intolerance. Workup?
Rectal exam, stool for occult blood CBC, electrolytes Stool for ova and parasitology AXR Fecal procalcitonin CT - abdomen/pelvis
33 yo M presents with watery diarrhea, vomiting, and diffuse abdominal pain that began yesterday. He also reports feeling hot. Several of his coworkers are also ill. Differentials?
Infectious diarrhea (gastroenteritis) - bacterial, viral, parasitic, protozoa
Food poisoning
Inflammatory bowel disease
33 yo M presents with watery diarrhea, vomiting, and diffuse abdominal pain that began yesterday. He also reports feeling hot. Several of his coworkers are also ill. Differentials: infectious diarrhea (gastroenteritis), food poisoning, inflammatory bowel disease. Workup?
Rectal exam, stool for occult blood
Stool leukocytes and culture
CBC, electrolytes
CT - abdomen/pelvis
40 yo F presents with watery diarrhea and abdominal cramps. Last week she was on antibiotics for a UTI. Differentials?
Pseudomembranous colitis (Clostridium difficile) Gastroenteritis Cryptosporidiosis Food poisoning Inflammatory bowel disease
40 yo F presents with watery diarrhea and abdominal cramps. Last week she was on antibiotics for a UTI. Differentials: pseudomembranous colitis (C. difficile), gastroenteritis, cryptosporidiosis, food poisoning, inflammatory bowel disease. Workup?
Rectal exam, stool for occult blood
Stool leukocytes, culture, occult blood
C. difficile toxin in stool
CBC, electrolytes
25 yo M presents with watery diarrhea and abdominal cramps. He was recently in Mexico. Differentials?
Traveler's diarrhea Giardiasis Amebiasis Food poisoning Hepatitis A
25 yo M presents with watery diarrhea and abdominal cramps. He was recently in Mexico. Differentials: traveler’s diarrhea, giardiasis, amebiasis, food poisoning, hepatitis A. Workup?
Rectal exam Stool leukocytes, culture, Giardia antigen, Entamoeba histolytical antigen Electrolytes AST/ALT/bilirubin/alkaline phosphatase Viral hepatitis serology
30 yo F presents with watery diarrhea and abdominal cramping and bloating. Her symptoms are aggravated by milk ingestion and are relieve by fasting. Differentials?
Lactose intolerance Gastroenteritis Inflammatory bowel disease Irritable bowel syndrome Hyperthyroidism
