A 57-year-old Wall Street broker has been suffering from intermittent constipation and diarrhea for several months. He complains of abdominal pain and a feeling of fullness. He has been taking Metamucil to add fiber to his diet and to have regular bowel movements, without consulting a doctor as he is too busy. After noticing that his feces are black in color for the last several days, he goes to see a doctor.
What additional tests will the doctor order?
List two possible clinical diagnoses. Explain your answer.
What are some possible treatments for each of the diagnoses?
There are several disorders that could fit symptoms of intermittent constipation and diarrhoea. Lactose intolerance, gluten intolerance (celiac disease ), or irritable bowel are some. One key to proper diagnosis would be the fact that the fiber did not help and eventually black stools developed, a sign of internal bleeding. This happened after taking the metamucil, which would be a rough irritant on the lining of the gastrointestinal (GI) tract and could have been what prompted the bleeding, allowing his condition to be noticed perhaps sooner than it may have otherwise.
Most doctors begin with the simplest of things with respect to tests. Tests and a starting point though are determined by symptoms. Most would do a thorough exam and ask the patient additional questions, perform a rectal exam, and also test for blood in the stool. The doctor will also need to know the exact color in order to help determine what location within the GI tract the blood is originating from, as blood can come from any point in the GI tract (mouth to anus ). A complete blood panel would provide insight into overall metabolic functions, renal functions, liver functions, immune functions, and they may perhaps check for cancer markers in the blood. Simple exams and bloodwork are usually the best starting points and then other tests are able to be ordered.
Sources for this section:
1. http://www.mayoclinic.com/health/symptom-checker/DS00671/SYMPTOM=29BC7DD7-2A5D-9994-E5E4AFF0259C6908&TAB=Abdominal%2520pain (Accessed on August 25, 2012)
2. http://www.medicinenet.com/upper_gi_series/article.htm (Accessed on August 25, 2012)
3. http://www.uptodate.com/contents/approach-to-acute-upper-gastrointestinal-bleeding-in-adults (Accessed on August 25, 2012)
Note regarding black- or tar-like stools:
The solution provides an extensive look at how to proceed with a patient with the symptoms described in the question as well as a couple clinical diagnoses and why they might be appropriate. 1061 words with sources.