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Case 5: 27F presents to the office with 3 months of alternating diarrhea and constipation, colicky abdominal pain relieved by defecation, and 3 days of non-bloody diarrhea containing mucus. No sick contact, no travel, no weight loss, no systemic sx's.

1. Emergency orders
2. Physical Exam
3. Diagnostic tests
4. Therapy
5. Location
6. Final order

1 Answer

4 votes

Final answer:

A detailed clinical evaluation is essential for a female patient with alternating diarrhea and constipation, abdominal pain, and mucus in stools, especially in the context of an increase in acute gastroenteritis-like symptoms in the community. Diagnostic tests, including stool analysis and blood work, are needed to exclude infectious causes. Treatment and location of care depend on the diagnosis, which may span from antidiarrheals to dietary changes for conditions like IBS.

Step-by-step explanation:

Clinical Assessment of Gastroenteritis-like Symptoms

A 27-year-old female presenting with symptoms of alternating diarrhea and constipation, colicky abdominal pain relieved by defecation, presence of mucus in diarrhea, but no systemic symptoms or weight loss, is suggestive of a functional gastrointestinal disorder such as Irritable Bowel Syndrome (IBS). However, given the spike in acute gastroenteritis-like symptoms seen in the hospital, a comprehensive evaluation to rule out infectious causes is warranted.

Emergency Orders and Physical Exam

No emergency orders are indicated unless the patient shows signs of severe dehydration or other systemic involvement. A thorough physical examination focusing on abdominal tenderness, signs of dehydration, and systemic signs should be conducted.

Diagnostic Tests

Diagnostic tests should include stool analysis to rule out infections (looking for blood, leukocytes, ova, and parasites), possibly blood tests to check for inflammatory markers, and tests to rule out metabolic or other systemic diseases that can present with gastrointestinal symptoms.

Therapy

Depending on findings, therapy may include antidiarrheals, antispasmodics, or specific antibiotics if an infectious agent is identified. In the case of IBS, long-term dietary modifications and stress management might be recommended.

Location

These assessments can typically be conducted in an outpatient setting unless the patient's condition warrants hospitalization due to severe symptoms or complications.

Final Order

Based on test results and clinical assessment, the final order may include specific treatments for the diagnosed condition and follow-up appointments to assess the progress and adjust the treatment plan accordingly.

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