Diagnosing Gastrointestinal Disorders

In primary care settings, patients often present with abdominal pain. Although this is frequently a sign of a gastrointestinal (GI) disorder, abdominal pain could also be the result of other systemic disorders, making this type of pain difficult to assess. While abdominal pain is most common, many other GI symptoms also overlap multiple disorders, further increasing the difficulty in diagnosing and treating patients. This makes provider-patient communication essential. You must be able to formulate questions that will prompt the patient to provide the necessary information, as this will guide your assessment and diagnosis. For this Discussion, consider potential diagnoses for the patients in the following case studies.
Case Study 1:
A 49-year-old man presents to the office complaining of vague abdominal discomfort over the past few days. He states he does not feel like eating and has not moved his bowels for the last 2 days. His patient medical history includes an appendectomy at age 22 and borderline hypertension, which he is trying to control with diet and exercise. He takes no medications and has no known allergies. Positive physical exam findings include a temperature of 99.9 degrees Fahrenheit, heart rate of 98, respiratory rate of 24, and blood pressure of 150/72. The abdominal exam reveals abdominal distention, diminished bowel sounds, and lower left quadrant tenderness without rebound.
Case Study 2:
A 40 year-old female presents to the office with the chief complaint of diarrhea. She has been having recurrent episodes of abdominal pain, diarrhea, and rectal bleeding. She has lost 9 pounds in the last month. She takes no medications, but is allergic to penicillin. She describes her life as stressful, but manageable. The physical exam reveals a pale middle- aged female in no acute distress. Her weight is 140 pounds (down from 154 at her last visit over a year ago), blood pressure of 94/60 sitting and 86/50 standing, heart rate of 96 and regular without postural changes, respiratory rate of 18, and O2 saturation 99%. Further physical examination reveals:
Skin: w/d, no acute lesions or rashes
Eyes: sclera clear, conj pale
Ears: no acute changes
Nose: no erythema or sinus tenderness
Mouth: membranes pale, some slight painful ulcerations, right buccal mucosa, tongue beefy red, teeth good repair
Neck: supple, no thyroid enlargement or tenderness, no lymphadenopathy
Cardio: S1 S2 regular, no S3 S4 or murmur
Lungs: CTA w/o rales, wheezes, or rhonchi
Abdomen: scaphoid, BS hyperactive, generalized tenderness, rectal +occult blood
Case Study 3:
A 52-year-old male presents to the office for a routine physical. The review of symptoms reveals anorexia, heartburn, and weight loss over the past 6 months. The heartburn is long standing, occurring most days during the week. He takes TUMS or Rolaids to relieve the discomfort. The patient describes occasional use of ibuprofen for back pain, but denies other medications including herbals. He has no known allergies. He was adopted so does not know his family history. Social history reveals that, although he stopped smoking ten years ago, he smoked for 20 years. He occasionally consumes alcohol on the weekends only. The only positive physical exam finding for this patient was slight epigastric tenderness. The remainder of his exam was negative and the rectal exam was negative for blood.
To prepare:
Review this week?s media presentations and Part 12 of the Buttaro et al. text in the Learning Resources.
Select one of the three case studies listed above. Reflect on the provided patient information including history and physical exams.
Think about a differential diagnosis. Consider the role the patient history and physical exam played in diagnosis.
Reflect on potential treatment options based on your diagnosis.

Required Resources
Readings
Buttaro, T. M., Trybulski, J., Polgar Bailey, P., & Sandberg-Cook, J. (2013). Primary care: A collaborative practice (4th ed.). St. Louis, MO: Mosby.
Part 12, ?Evaluation and Management of Gastrointestinal Disorders? (pp. 612?722)

This part examines the pathophysiology and clinical presentation of several GI disorders. It also describes diagnostic criteria, differential diagnosis, and management methods for GI disorders.
Part 20, ?Evaluation and Management of Infectious Disease?
Chapter 234, ?Infectious Diarrhea? (pp. 1263?1271)

This chapter describes characteristics of three types of infectious diarrhea and identifies the pathophysiology, clinical presentation, treatment options, and possible causes of the disorder.
Media
Laureate Education, Inc. (Executive Producer). (2013c). Case study: Male abdominal disorder. Baltimore, MD: Author.

Note: The approximate length of this media piece is 7 minutes.

This media presentation features an evaluation of a female patient presenting with abdominal pain.

Accessible player
Laureate Education, Inc. (Executive Producer). (2013d). Case study: Female abdominal disorder. Baltimore, MD: Author.

Note: The approximate length of this media piece is 11 minutes.

This media presentation features an evaluation of a male patient presenting with abdominal pain.

Accessible player
Optional Resources
American Liver Foundation (n.d.). Retrieved November 28, 2012, from http://www.liverfoundation.org/
Drugs.com. (n.d.). Retrieved November 28, 2012, from www.drugs.com
Institute for Safe Medication Practices. (n.d.). Retrieved from http://www.ismp.org/
National Digestive Diseases Information Clearinghouse. (n.d.). Retrieved November 28, 2012, from http://digestive.niddk.nih.gov/index.aspx
WebMD. (2012). Medscape. Retrieved from http://www.medscape.com/
Please proceed to the Discussion.

**INSTRUCTIONS FOR PAPER**
Write an explanation of the differential diagnosis for the patient in the case study that you selected(CASE STUDY #3). Describe the role the patient history and physical exam played in the diagnosis. Then, suggest potential treatment options based on your patient diagnosis.