Question

A 28-year-old female patient complains of intermittent abdominal pain, accompanied by diarrhea or sometimes constipation. This has been happening off and on over the past few years and recently has been interrupting her daily activities.

a. As the medical assistant interviewing this patient, what are some standard questions that you might ask her about her symptoms?

b. Why is this information so important for the doctor to know and what tests would most likely be ordered?

Answer 1

Some standard Interview Questions for the Patient are

Pain:

Location: Where exactly in the abdomen is the pain? Upper, lower, left, right, around the belly button?

Severity: How bad is the pain on a scale of 1-10, with 10 being the worst?

Character: Is the pain sharp, dull, cramping, burning, stabbing?

Duration: How long does each episode of pain last? Minutes, hours, days?

Frequency: How often do you experience these episodes? Daily, weekly, monthly?

What are the other standard Interview Questions for the Patient?

Bowel Habits:

Stool characteristics: Consistency (loose, watery, formed), color, blood or mucus presence?

Frequency: How often do you have bowel movements? Daily, every few days, more often?

Urgency: Do you feel a sudden urge to have a bowel movement that's hard to control?

Straining: Do you need to strain to have a bowel movement?

Additional Questions:

Have you experienced any weight loss or fever?

Do you have any other medical conditions or are taking any medications?

Is there any family history of digestive problems?

How is this affecting your daily life and activities?

b. Importance of Information and Potential Tests:

Importance:

This information is crucial for the doctor to diagnose the underlying cause of the patient's abdominal pain and irregular bowel movements. The details help differentiate between various conditions like irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), celiac disease, lactose intolerance, or even infections.

Potential Tests:

Stool test: To check for blood, mucus, bacteria, parasites, or signs of inflammation.

Blood test: To evaluate overall health, inflammatory markers, and rule out other conditions.

Urinalysis: To exclude urinary tract infections contributing to abdominal pain.

Imaging tests: Abdominal X-ray, ultrasound, or CT scan for a closer look at the digestive organs.

Endoscopy: Colonoscopy or sigmoidoscopy to directly examine the inside of the colon.

The specific tests ordered will depend on the doctor's assessment and initial findings during the interview and physical examination.