A 56-year-old male complains of anorexia, changes in bowel ...

[mydiamond]

A 56-year-old male complains of anorexia, changes in bowel habits, extreme fatigue, and unintentional weight loss. At times he is constipated and other times he has episodes of diarrhea. His physical examination is unremarkable.
 
  It is important for the clinician to recognize the importance of:
  A. CBC with differential
  B. Stool culture and sensitivity
  C. Abdominal x-ray
  D. Colonoscopy

Question 2

A 20-year-old engineering student complains of episodes of abdominal discomfort, bloating, and episodes of diarrhea. The symptoms usually occur after eating, and pain is frequently relieved with bowel movement.
 
  She is on a celiac diet and the episodic symptoms persist. Physical examination and diagnostic tests are negative. Colonoscopy is negative for any abnormalities. This is a history and physical consistent with:
  A. Inflammatory bowel disease
  B. Irritable bowel syndrome
  C. Laxative abuse
  D. Norovirus gastroenteritis

[kilada]

Answer to Question 1

ANS: D
The symptoms and severity of the diarrhea vary according to the underlying cause. The symptoms of carcinomas are generally insidious. The diarrhea is mild and intermittent. Often malignancies are found on routine hemoccults, sigmoidoscopy, or colonoscopy. There should be a high index of suspicion with unexplained weight loss or new-onset iron-deficiency anemia in a patient over 40 years old.

Answer to Question 2

ANS: B
Irritable bowel syndrome (IBS) is a functional bowel disorder characterized by mild to severe abdominal pain, discomfort, bloating, and alteration of bowel habits. The exact cause is unknown. In some cases, the symptoms are relieved by bowel movements. Diarrhea or constipation may predominate, or they may be mixed (classified as IBS-D, IBS-C, or IBS-M, respectively). IBS may begin after an infection (postinfectious, IBS-PI) or a stressful life event. IBS is a motility disorder involving the upper and lower GI tracts that causes intermittent nausea, abdominal pain and distention, flatulence, pain relieved by defecation, diarrhea, and/or constipation. Symptoms usually occur in the waking hours and may be worsened or triggered by meals. It is three times more prevalent in women, accounts for more than half of all GI referrals, and is highly correlated with emotional factors, particularly anxiety and stress.