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Question: An 18-year-old white female presents to your clinic today with a 2-week history of intermittent abdominal pain. She also is positive for periodic cramping and diarrhea as well as low-grade fever.

23 Oct 2022,1:18 AM

 

An 18-year-old white female presents to your clinic today with a 2-week history of intermittent abdominal pain. She also is positive for periodic cramping and diarrhea as well as low-grade fever. She also notes reduced appetite. She notes that She admits to smoking ½ PPD for the last 2 years. Denies any illegal drug or al​‌‍‍‍‌‍‍‌‍‌‌‌‍‍‌‍‍‌‌‍​cohol use. Does note a positive history of Crohn's Disease. Based on the information provided answer the following questions: 1. What are the top 3 differentials you would consider with the presumptive final diagnosis listed first? 2. What focused physical exam findings would be beneficial to know? 3. What diagnostic testing needs to be completed if any to confirm the diagnosis? 4. Using evidence-based treatment guidelines note a treatment pla​‌‍‍‍‌‍‍‌‍‌‌‌‍‍‌‍‍‌‌‍​n.

Expert answer

 

1. What are the top 3 differentials you would consider with the presumptive final diagnosis listed first?

- Inflammatory bowel disease (IBD)

- Irritable bowel syndrome (IBS)

- Celiac disease

 

2. What focused physical exam findings would be beneficial to know? 3. What diagnostic testing needs to be completed if any to confirm the diagnosis?

The focused physical exam findings that would be beneficial to know in this case are the presence of any signs of intestinal bleeding, such as guaiac positive stool or melena. Additionally, it would be important to know if the patient has any evidence of an abscess or fistula formation. Additionally, a thorough rectal exam should be performed to check for any evidence of proctitis. Finally, a general assessment of the patient's overall appearance and vitals should be conducted.

 

 

What are some differentials for the presenting symptoms?

The most likely differential diagnoses for the patient's symptoms include IBD, IBS, and celiac disease. However, other possible causes of her symptoms include infectious colitis, ischemic colitis, and diverticular disease.

 

What diagnostic tests would you order?

There are a variety of diagnostic tests that could be ordered in this case, depending on the clinical suspicion. If IBD is suspected, tests such as stool studies for inflammation or Clostridium difficile toxin, ileocolonoscopy, and/or computed tomography (CT) enterography may be ordered. If IBS is suspected, tests such as a hydrogen breath test or small bowel imaging may be ordered. If celiac disease is suspected, serologic testing for tissue transglutaminase antibodies or endomysial antibodies may be ordered. Additionally, upper endoscopy with biopsy may be conducted to rule out other causes of her symptoms, such as gastrointestinal bleeding or malignancy.

 

What is the most likely diagnosis?

The most likely diagnosis in this case is IBD, given the patient's history of Crohn's disease. However, additional testing will be needed to confirm the diagnosis.

 

 

What are some differentials for the presenting symptoms?

The most likely differential diagnoses for the patient's symptoms include IBD, IBS, and celiac disease. However, other possible causes of her symptoms include infectious colitis, ischemic colitis, and diverticular disease.

 

What diagnostic tests would you order?

There are a variety of diagnostic tests that could be ordered in this case, depending on the clinical suspicion. If IBD is suspected, tests such as stool studies for inflammation or Clostridium difficile toxin, ileocolonoscopy, and/or computed tomography (CT) enterography may be ordered. If IBS is suspected, tests such as a hydrogen breath test or small bowel imaging may be ordered. If celiac disease is suspected, serologic testing for tissue transglutaminase antibodies or endomysial antibodies may be ordered. Additionally, upper endoscopy with biopsy may be conducted to rule out other causes of her symptoms, such as gastrointestinal bleeding or malignancy.

 

What is the most likely diagnosis?

The most likely diagnosis in this case is IBD, given the patient's history of Crohn's disease. However, additional testing will be needed to confirm the diagnosis.

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