Constipation/diarrhea

Question 1

Key history in constipation/diarrhea

Answer 1

Frequency, color, odor and volume of stools
Presence of mucus or flatulence
Whether stools float in bowl
Duration of change in bowel habits
Other symptoms (constitutional, abdominal pain, bloating, tenesmus, sense of incomplete evacuation, melena or hematochezia)
Thyroid disease symptoms (e.g. feeling hot, palpitations, weight loss)
Diet (especially fiber and fluid intake)
Medications (including recent antibiotics)
Sick contacts
Travel and camping history
HIV risk factors
Hx of abdominal surgeries, DM, pancreatitis
Alcohol and drug use
FHx of colon cancer

Question 2

Key physical exam in constipation/diarrhea

Answer 2

Vital signs
Relevant thyroid/endocrine exam
Abdominal and rectal exams
+/- Pelvic exam

Question 3

67 yo M with alternating diarrhea and constipation, decreased stool caliber and blood in stool for last eight months
\+ unintentional weight loss
\+ low fiber diet
\+ FHx of colon cancer
\+ last colonoscopy was 12 years ago

Answer 3

Colorectal cancer
IBS
Diverticulosis

Rectal exam, stool for occult blood, CBC, electrolytes, AST/ALT/bilirubin/alkaline phosphatase, colonoscopy, barium enema, CT - abdomen/pelvis

Question 4

28 yo M with constipation for last three weeks

+ only eats junk food

Answer 4

Low-fiber diet
IBS
Depression
Substance use (e.g. heroin)
Hypothyroidism

Rectal exam, TSH, electrolytes, urine toxicology

Question 5

30 yo F with alternating constipation and diarrhea
+ abdominal pain relieved by defecation
+ no N/V, weight loss, or blood in stool

Answer 5

IBS
IBD
Celiac disease

Rectal exam, stool for occult blood, CBC, electrolytes, colonoscopy, stool for ova and parasitology, CT - abdomen and pelvis

Question 6

33 yo M with watery diarrhea, vomiting and diffuse abdominal pain that began yesterday
+ feels hot
+ several other coworkers feel ill, too

Answer 6

Infectious diarrhea (gastroenteritis)
Food poisoning

Rectal exam, stool for occult blood, stool leukocytes and culture, CBC, electrolytes, CT - abdomen/pelvis

Question 7

40 yo F with watery diarrhea and abdominal cramps

+ recent antibiotic use

Answer 7

Pseudomembranous colitis
Gastroenteritis
Cryptosporidiosis
Food poisoning

Stool for C. difficile toxin, rectal exam, stool for occult blood, stool leukocytes and culture, CBC, electrolytes

Question 8

25 yo M with watery diarrhea and abdominal cramps

+ recent travel to Mexico

Answer 8

Traveler’s diarrhea
Giardiasis
Amebiasis
Hepatitis A

Rectal exam, stool leukocytes and culture, Giardia antigen, Entamoeba histolytica antigen, CBC, electrolytes, AST/ALT/bilirubin/alkaline phosphatase, viral hepatitis serologies

Question 9

30 yo F with watery diarrhea, abdominal cramps and bloating

+ symptoms aggravated by milk and relieved by fasting

Answer 9

Lactose intolerance
Gastroenteritis
IBD

Rectal exam, stool leukocytes and culture, hydrogen breath test, TSH

Question 10

33 yo M with watery diarrhea, diffuse abdominal pain and weight loss over last three weeks
+ not improved by antibiotics

Answer 10

Crohn's disease
Gastroenteritis
Ulcerative colitis
Celiac disease
Carcinoid syndrome

Rectal exam, stool for occult blood, stool leukocytes and culture, CBC, electrolytes, colonoscopy, CT - abdomen, TSH, small bowel series, 5-HIAA