CONSTIPATION / DIARRHEA

Question 1

67 yo M presents with alternating
diarrhea and constipation, decreased
stool caliber, and blood in the stool for
the past eight months. He also reports
unintentional weight loss. He is on a
low-fi ber diet and has a family history
of colon cancer.

Answer 1

Colorectal cancer CBC
Irritable bowel syndrome AST/ALT/bilirubin/alkaline phosphatase
Diverticulosis Colonoscopy
GI parasitic infection (ascariasis, Barium enema
giardiasis)
Infl ammatory bowel disease CT—abdomen/pelvis
Angiodysplasia

Question 2

28 yo M presents with constipation (very
hard stool) for the last three weeks. Since
his mother died two months ago, he and
his father have eaten only junk food.

Answer 2

Low-fiber diet Rectal exam
Irritable bowel syndrome TSH
Substance abuse (e.g., heroin) Electrolytes
Depression Urine toxicology
Hypothyroidism

Question 3

30 yo F presents with alternating
constipation and diarrhea and abdominal
pain that is relieved by defecation. She
has no nausea, vomiting, weight loss, or
blood in her stool.

Answer 3

Irritable bowel syndrome Rectal exam, stool for occult blood
Infl ammatory bowel disease CBC
Celiac disease Electrolytes
Chronic pancreatitis Stool for ova and parasitology
GI parasitic infection (ascariasis, AXR
giardiasis) CT—abdomen/pelvis
Lactose intolerance

Question 4

33 yo M presents with watery diarrhea,
vomiting, and diffuse abdominal pain
that began yesterday. He also reports
feeling hot. Several of his coworkers are
also ill.

Answer 4

Infectious diarrhea Rectal exam, stool for occultblood
(gastroenteritis)—bacterial, Stool leukocytes and culture
viral, parasitic, protozoal CBC
Food poisoning Electrolytes
Inflammatory bowel disease CT—abdomen/pelvis

Question 5

40 yo F presents with watery diarrhea
and abdominal cramps. Last week she
was on antibiotics for a UTI.

Answer 5

Pseudomembranous Rectal exam
(Clostridium diffi cile) coliti Stool leukocytes, culture, occult blood
Gastroenteritis C. difficile toxin in stool
Cryptosporidiosis Electrolytes
Food poisoning
Inflammatory bowel disease

Question 6

25 yo M presents with watery diarrhea
and abdominal cramps. He was recently
in Mexico.

Answer 6

Traveler’s diarrhea
Giardiasis
Amebiasis
Food poisoning
Hepatitis A

Rectal exam
Stool leukocytes, culture,
Giardia antigen, Entamoeba
histolytica antigen
Electrolytes
AST/ALT/bilirubin/alkaline
phosphatase
Viral hepatitis serology

Question 7

30 yo F presents with watery diarrhea
and abdominal cramping and bloating.
Her symptoms are aggravated by milk
ingestion and are relieved by fasting.

Answer 7

Lactose intolerance Rectal exam
Gastroenteritis Stool exam
Inflammatory bowel disease Hydrogen breath test
Irritable bowel syndrome TSH
Hyperthyroidism

Question 8

33 yo M presents with watery diarrhea,
diffuse abdominal pain, and weight loss
over the past three weeks. He has not
responded to antibiotics.

Answer 8

Crohn’s disease Rectal exam
Gastroenteritis Stool exam and culture
Ulcerative colitis CBC, electrolytes
Celiac disease TSH
Pseudomembranous colitis CT—abdomen
Hyperthyroidism Colonoscopy
Small bowel lymphoma Small bowel series
Carcinoid Urinary 5-HIAA