Gastrointestinal & Endocrine Case Study

Sample Solution

Patient Case Analysis: 37-Year-Old Female with Diarrhea

1. What additional questions should you ask the patient and why?

Given the chief complaint of frequent and watery bowel movements, the patient's age, and initial vital signs/physical exam, here are crucial additional questions to ask and their rationale:

Regarding the Diarrhea:

• "When exactly did the 'loose stools' start? You said 'about three days' - can you pinpoint it more precisely?"
  • Why: To establish a more precise timeline. Acute diarrhea is typically < 14 days, persistent is 14-30 days, and chronic is > 30 days. This helps narrow down causes.
• "How many bowel movements have you had in the last 24 hours? And in the last 12 hours?"
  • Why: "One event about every three hours" is vague. Quantifying the frequency helps assess severity and fluid loss.
• "Can you describe the consistency of the stools? Are they entirely liquid, mushy, or do they have some form?"
  • Why: Helps distinguish between secretory (watery, high volume) and inflammatory (bloody, mucoid, smaller volume) diarrhea.
• "What color are the stools?"
  • Why: Green, yellow, or pale stools can indicate different issues (e.g., rapid transit, giardiasis).
• "Have you had any urgency or tenesmus (feeling of incomplete evacuation) with the bowel movements?"
  • Why: Urgency and tenesmus often suggest inflammation of the rectum or colon (e.g., IBD, infectious colitis).
• "Is the diarrhea worse after eating certain foods or at certain times of the day?"
  • Why: Can point to food intolerance, malabsorption, or post-prandial dumping.
• "Has anyone else in your household, workplace, or social circle had similar symptoms recently?"
  • Why: To identify a potential outbreak or contagious source (e.g., viral gastroenteritis).

Associated Symptoms:

• "You mentioned nausea. Have you had any vomiting?" If yes, "How many times? What did it look like?"
  • Why: To assess for additional fluid loss and severity of GI upset.
• "Regarding the flatulence, is it more than usual? Is it particularly foul-smelling?"
  • Why: Excessive or foul-smelling flatulence can be a symptom of malabsorption or specific infections (e.g., Giardia).
• "Are you experiencing any abdominal cramping, bloating, or distension beyond the mild tenderness you mentioned?"
  • Why: To further characterize the abdominal discomfort.
• "Any joint pain, skin rashes, or eye irritation?"
  • Why: To screen for extra-intestinal manifestations of inflammatory bowel disease (IBD).
• "Have you noticed any unintentional weight loss over a longer period (e.g., past 3-6 months)?"
  • Why: Significant weight loss despite intake could suggest chronic malabsorption or underlying systemic disease, though her BMI is already low.
• "Any dizziness, lightheadedness, or feeling faint when you stand up?"
  • Why: To assess for orthostatic hypotension due to dehydration.