Question

A 35 year old white woman presents with recurrent, crampy abdominal pain that has been occurring over the past several years. the pain has become increasingly severe and debilitating over the past few months. it is usually relieved by a bowel movement. she has a pattern of intermittent constipation and loose stools. she denies blood in the stool. the pain tends to be diffuse in nature and seems unrelated to diet, exercise and/or stress. she's new to your practice, having moved to the geographic area only recently (over the past few months) related to her husband's job. she has stayed with the same firm although is in a new location.

" i want to find out what is wrong. I am tired of always worrying about where a bathroom is"!

The physical reveals an essentially normal abdominal exam and overall negative general exam. stool is negative for blood and mucus. The patient is of normal height and weight, does not smoke. drinks only socially, has a good job, denies excessive stress and is married without children. No recent weight loss .

• What additional data may you need from this patient?
• What (if any) laboratory tests do you need and why?
• What is your list of working diagnoses? How do you rule each out to come to a diagnostic conclusion/label?
• What plan of care would you devise for this patient?
• What follow-up is needed? What patient education is important? What health promotion strategies are important for this patient at this time?
• What complementary therapies might be helpful for this patient? Support with evidence from the scientific (i.e., data-based) literature

Answer 1

#The additional data which may be needed from the patient are

• The location of the pain and duration of pain
• Use of any medication
• Any past medical and surgical history
• Food allergies

#The laboratory test which is needed to be done are

• CBC: to rule out any infection
• H .Pylori bacteria (cause gastrointestinal problems)
• Urine analysis

#The list of working diagnosis are

• To rule out disease of colon like diverticulitis, colitis because this cause recurrent crampy pain, alteration on bowel and bladder pattern
• To rule UTI which can pain
• Problem associated to reproductive system
• Irritable bowel syndrome has symptoms of cramps abdominal pain ,diarrhea or constipation

#The plan of care needed for this patient are

• Pain management
• Maintain bowel pattern
• Dietary modification
• Diagnostic procedures to rule out the cause

#The follow up and patient education  needed for the patient are

• Medication adherence
• Periodic follow up and adviced
• Follow high fiber diet ,increase fruits and vegetables in diet
• Follow regular daily bowel pattern
• Adequate fluid intake

#The complementary therapy like acupuncture based on evidenced based practice has a good pain relieving techniques .