Chapter 25 Abnormalities in bowel or urination habits Case 25.1 Following an appendectomy, 23-year-old Robert complains of abdominal distension and generalised abdominal discomfort. There is some nausea, and he has vomited twice over the last 12 hours since he returned from the recovery ward. He has not yet passed any faeces or flatus. On examination, Robert’s abdomen appears bloated, there is some discomfort with abdominal palpation, and no bowel sounds are heard on auscultation. Questions 1. What is the most likely diagnosis? 2. Is this an unusual situation? Why or why not? 3. What are other possible causes of this disorder? Case 25.2 Ian is a regular patient, who mentions to you in passing that he has had a long-term problem with constipation since childhood. It varies in severity, but can have episodes of up to 5 days without passing stools. He states that his abdomen is often bloated, and he complains of excessive gas formation. Questions 1. What pertinent questions must you ask Ian, in order to determine the cause of his problem? 2. What are some of the more likely causes of his problem? 3. For each of your answers to question 2, explain how each can result in constipation. Case 25.3 Chronic diarrhoea is a problem for Anna, a 33-year-old female. For 6 months she has noticed that she sporadically gets ‘the runs’, but that she can go for days without any problem. She describes her stools as frothy and watery, and she is embarrassed by the amount of gas she seems to produce. The first time she had the problem, the diarrhoea was very severe, and associated with cramping, nausea and vomiting. She had a fever. After about a week her symptoms subsided. However, by the time she returned to a normal diet she noticed the return of diarrhoea. However, it has never been as severe since that initial episode. Questions 1. What is your differential diagnosis, based only on this information? 2. What questions would be pertinent to ask? 3. Physical examination is normal. What investigations would be relevant? Case 25.4 Joan is a 42-year-old female who presents with a recent onset of constipation. It has been very insidious, and she does not know exactly when it started. She thinks it may be about 6 months ago when she first noticed the changes. Constipation is unusual for her, as she has usually been quite regular. She also states that she feels bloated, with a sense of fullness in her lower abdomen. There is no rectal bleeding or any other gastrointestinal symptom. Her diet and levels of activity have not altered over this period. Systems review reveals a recent onset of dysmenorrhoea and menorrhagia over the last year, and the development of some varicose veins in her lower limbs. Physical examination is normal. Questions 1. What is your differential diagnosis? 2. What investigations should be done to confirm your diagnosis? 3. Explain the mechanisms by which your diagnosis may be causing her symptoms. Case 25.5 Halle is a 21-year-old female who presents with a sudden onset of right-sided loin pain, dysuria, fever, rigors, nausea, vomiting, anorexia and frequency of urination. She has cloudy urine. There have been no previous episodes. Questions 1. What is the most likely diagnosis? 2. What investigations should be done to confirm this? 3. What is the usual cause of this disorder? Case 25.6 History Bridget is a 24-year-old woman who has had a number of episodes of abdominal pain, bloating and diarrhoea over the previous 2 years. The pain is most often located in the lower abdomen, sometimes localised to the left lower quadrant, but can also be found in other regions of the abdomen. She describes the sensation as a constant dull ache, with occasional exacerbations of crampy, more severe pain. Whenever she has pain in the left upper quadrant, it is often referred to her left shoulder as well. The usual precipitating factor is eating, and defecation or the expulsion of gas will often relieve the pain. Bridget has noticed that certain foods tend to be associated with pain. Abdominal distension often accompanies the pain, and is similarly relieved by the same factors. Bridget’s diarrhoea often, but not always, accompanies these episodes, but may also occur without the pain or bloating. She has not noticed any blood in her stools, but does comment about the frequent presence of mucus. Bridget has episodes of diarrhoea approximately 5–6 days each month. The length of time between episodes varies. There is also a degree of urgency which accompanies it. The faeces is brown in colour, not pale, and flushes normally. Her stools between these episodes are normal. Bridget has no nausea, vomiting, constipation, anorexia or dysphagia. There has been no weight loss. Bridget works in the retail industry and is in a stable and happy relationship. She is a non-smoker, drinks socially, and her only medications are the oral contraceptive pill and multivitamins. Relevant family history is a grandfather who died from carcinoma of the colon. Past medical history is unremarkable. Questions 1. Using only this information, list your differential diagnoses for Bridget’s presentation. Justify your answer. Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: Eating disorders, substance abuse and behavioural disturbances in adolescence Miscellaneous cases in infancy and childhood Sports injuries Acute joint pain Acute back pain Upper limb pain Stay updated, free articles. Join our Telegram channel Join Tags: Cases in Differential Diagnosis for the Physical and Manipulativ Dec 26, 2016 | Posted by admin in MANUAL THERAPIST | Comments Off on Abnormalities in bowel or urination habits Full access? 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Chapter 25 Abnormalities in bowel or urination habits Case 25.1 Following an appendectomy, 23-year-old Robert complains of abdominal distension and generalised abdominal discomfort. There is some nausea, and he has vomited twice over the last 12 hours since he returned from the recovery ward. He has not yet passed any faeces or flatus. On examination, Robert’s abdomen appears bloated, there is some discomfort with abdominal palpation, and no bowel sounds are heard on auscultation. Questions 1. What is the most likely diagnosis? 2. Is this an unusual situation? Why or why not? 3. What are other possible causes of this disorder? Case 25.2 Ian is a regular patient, who mentions to you in passing that he has had a long-term problem with constipation since childhood. It varies in severity, but can have episodes of up to 5 days without passing stools. He states that his abdomen is often bloated, and he complains of excessive gas formation. Questions 1. What pertinent questions must you ask Ian, in order to determine the cause of his problem? 2. What are some of the more likely causes of his problem? 3. For each of your answers to question 2, explain how each can result in constipation. Case 25.3 Chronic diarrhoea is a problem for Anna, a 33-year-old female. For 6 months she has noticed that she sporadically gets ‘the runs’, but that she can go for days without any problem. She describes her stools as frothy and watery, and she is embarrassed by the amount of gas she seems to produce. The first time she had the problem, the diarrhoea was very severe, and associated with cramping, nausea and vomiting. She had a fever. After about a week her symptoms subsided. However, by the time she returned to a normal diet she noticed the return of diarrhoea. However, it has never been as severe since that initial episode. Questions 1. What is your differential diagnosis, based only on this information? 2. What questions would be pertinent to ask? 3. Physical examination is normal. What investigations would be relevant? Case 25.4 Joan is a 42-year-old female who presents with a recent onset of constipation. It has been very insidious, and she does not know exactly when it started. She thinks it may be about 6 months ago when she first noticed the changes. Constipation is unusual for her, as she has usually been quite regular. She also states that she feels bloated, with a sense of fullness in her lower abdomen. There is no rectal bleeding or any other gastrointestinal symptom. Her diet and levels of activity have not altered over this period. Systems review reveals a recent onset of dysmenorrhoea and menorrhagia over the last year, and the development of some varicose veins in her lower limbs. Physical examination is normal. Questions 1. What is your differential diagnosis? 2. What investigations should be done to confirm your diagnosis? 3. Explain the mechanisms by which your diagnosis may be causing her symptoms. Case 25.5 Halle is a 21-year-old female who presents with a sudden onset of right-sided loin pain, dysuria, fever, rigors, nausea, vomiting, anorexia and frequency of urination. She has cloudy urine. There have been no previous episodes. Questions 1. What is the most likely diagnosis? 2. What investigations should be done to confirm this? 3. What is the usual cause of this disorder? Case 25.6 History Bridget is a 24-year-old woman who has had a number of episodes of abdominal pain, bloating and diarrhoea over the previous 2 years. The pain is most often located in the lower abdomen, sometimes localised to the left lower quadrant, but can also be found in other regions of the abdomen. She describes the sensation as a constant dull ache, with occasional exacerbations of crampy, more severe pain. Whenever she has pain in the left upper quadrant, it is often referred to her left shoulder as well. The usual precipitating factor is eating, and defecation or the expulsion of gas will often relieve the pain. Bridget has noticed that certain foods tend to be associated with pain. Abdominal distension often accompanies the pain, and is similarly relieved by the same factors. Bridget’s diarrhoea often, but not always, accompanies these episodes, but may also occur without the pain or bloating. She has not noticed any blood in her stools, but does comment about the frequent presence of mucus. Bridget has episodes of diarrhoea approximately 5–6 days each month. The length of time between episodes varies. There is also a degree of urgency which accompanies it. The faeces is brown in colour, not pale, and flushes normally. Her stools between these episodes are normal. Bridget has no nausea, vomiting, constipation, anorexia or dysphagia. There has been no weight loss. Bridget works in the retail industry and is in a stable and happy relationship. She is a non-smoker, drinks socially, and her only medications are the oral contraceptive pill and multivitamins. Relevant family history is a grandfather who died from carcinoma of the colon. Past medical history is unremarkable. Questions 1. Using only this information, list your differential diagnoses for Bridget’s presentation. Justify your answer. Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: Eating disorders, substance abuse and behavioural disturbances in adolescence Miscellaneous cases in infancy and childhood Sports injuries Acute joint pain Acute back pain Upper limb pain Stay updated, free articles. Join our Telegram channel Join Tags: Cases in Differential Diagnosis for the Physical and Manipulativ Dec 26, 2016 | Posted by admin in MANUAL THERAPIST | Comments Off on Abnormalities in bowel or urination habits Full access? 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