Cs Abdominal pain

CASE SCENARIO

• Fatima, a 30-year-old teacher, presents to you with a history of hard pellet-like stools and difficulty evacuating her bowel.
• She states that she constantly feels bloated but sometimes experiences abdominal cramps.
• Her symptoms started when she was in her late teens and were tolerable until about 6 months ago.
• She attributes the worsening symptoms to increased stress at work and her recent appointment as the school principal.

CASE SCENARIO

• She complains of abdominal pain and bloating almost continuously throughout the day for the past 2 months, although her symptoms are somewhat alleviated by passing stool.
• She tried taking laxative powder but could not stand the taste and wasn’t sure how much it was helping.

Physical Examination

• BP 126/84 mmHg
• Weight 68 kg, Height 170 cm, WC 74 cm
• Abdomen resonant on percussion with slight tenderness in the left iliac fossa (LIF)
• No abdominal or rectal masses, bowel sounds normal

Additional examinations:

• Abdominal x-rays and abdomen ultrasound (2 months ago) both were normal

Case Summary Instructions

• Please, write a short summary of the case, before you proceed further.
• Write some thoughts on what could be done for this patient.

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Patient Case Summary

• A 50-year-old businessman, who is complaining of dyspepsia for the last two years. He had received H-Pylori eradication therapy one year ago.

• Now he is on PPI 20 mg/day. He has stressful work conditions and he is a heavy smoker. Today he is insisting to refer him for urgent endoscopy.

• You are going to discuss with the patient that the urgent specialist referral for endoscopy (to be seen within two weeks) is indicated for patients of any who fulfill which one of the following criteria?

  1. A. Epigastric discomfort of more than one year
  2. B. Failed H-Pylori eradication
  3. C. Significant acute gastrointestinal bleeding
  4. D. Progressive unintentional weight loss

Medical Case Study

A 48-year-old hairdresser has been troubled with an altered bowel habit and abdominal discomfort for five months. She was told that she has irritable bowel syndrome and that no further investigation is deemed necessary.

The development of which one of the following symptoms warrants further evaluation?

• A. Recent onset of nausea.
• B. Diarrhoea with mucus discharge.
• C. Persistence of symptoms for 24 weeks.
• D. Weight loss.

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Case Scenario:

• A 43-year-old man, who works as a taxi driver for a long time, has presented to the clinic today with the complaint of indigestion and upper abdominal pain.
  • These complaints initiated for the last 3 months.
  • Pain and indigestion are usually felt after heavy meals.
  • His bowel movements are normal.
• He does not use NSAID, but he is a smoker, 10-20 cigarettes per day.
• No history of:
  • hematemesis or melena.
  • recent weight loss or generalized weakness.
• He is not known to have any other chronic illness.

Initially, he could manage this problem taking antacid brought over the counter, but during the last week he could not get relief from the antacid and has vomited 2-3 times.

On Examination:

• Looks well, not in pain, not pale or jaundiced

• Abdominal examination was normal, apart from tenderness in the upper abdomen; in the gastric region

• Please, summarize the case on a piece of paper.