The Rational Clinical Examination
David L. Simel, Drummond Rennie
Irritable Bowel Syndrome
Alexander C. Ford, Nicholas J. Talley, Sander J. O. Veldhuyzen van Zanten, Nimish B. Vakil, David L. Simel, Paul Moayyedi
Sections:
Patient Scenario, Why Is the Clinical Examination Important?, Methods, Results, Scenario Resolution, The Bottom Line, References
Topics Discussed:
irritable bowel syndrome
Excerpt:
"A 35-year-old woman presents with a 6-month
history of lower gastrointestinal tract symptoms. She describes
lower abdominal discomfort along with a long standing fluctuating
bowel habit, such that her stools often occur more frequently and
with looser consistency. In addition, she experiences a sense of
incomplete evacuation after defecation. She specifically denies
any weight loss or the passage of blood or mucus per rectum. Her
symptoms are unrelated to menstruation. She has always been healthy
and is not taking any regular prescribed or over-the-counter
medications. Her father was diagnosed with colorectal carcinoma
at age 80 years. You notice that she is thin but without pallor.
Her abdomen is soft and nontender, without palpable organomegaly
or masses. Results of a digital rectal examination are normal. Complete
blood cell count (CBC) and erythrocyte sedimentation rate (ESR)
results are normal. While you suspect irritable bowel syndrome (IBS),
are the symptoms convincing enough to you (and the patient) that
no further investigation is necessary?..."
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