Gastrointestinal & Endocrine
For this Discussion, you will take on the role of a clinician who is building a health history for one of the following cases. Your instructor will assign you your case number.
Case 1Case 2Case 3Chief Complaint
(CC) “I am here today due to frequent and watery bowel movements”“I have pain in my belly”“neck swelling”History of Present Illness (HPI)A 37-year-old European American female presents to your practice with “loose stools” for about three days. One event about every three hoursA 25-year-old female presents to the emergency room (ER) with complaints of severe abdominal pain for 2 weeks . The pain is sharp and crampy It hurts if I run, sit down hard, or if I have sexA 42-year-old African American female who refers that she has been noticing slow and progressive swelling on her neck for about a year. Also she stated she has lost weight without any food restrictionPMHNo contributory Patient deniesPatient denies PSHAppendectomy at the age of 14 Surgical removal of benign left breast nodule 2 years agoDrug Hx
No medsBirth controlNo medication at the timeAllergiesPenicillinNKANKASubjectiveFever and chills, Lost appetite Flatulence No mucus or blood on stoolsNausea and vomiting, Last menstrual period 5 days ago, New sexual partner about 2 months ago, No condoms, he hates them No pain, blood or difficulty with urinationMild difficult to shallow, Neck feels tight, Pt states she feels PalpitationsObjective Data PEB/P 188/96; Pulse 89; RR 16; Temp 99.0; Ht 5,6; wt 110; BMI 17.8B/P 138/90; temperature 99°F; (RR) 20; (HR) 110, regular; oxygen saturation (PO2) 96%; pain 5/10 B/P 158/90; Pulse 102; RR 20; Temp 99.2; Ht 5,4; wt 114; BMI 19.6 Generalwell-developed female in no acute distress, appears slightly fatiguedacute distress and severe pain42-year-old female appears thin. She is anxious – pacing in the room and fidgeting, but in no acute distress. HEENTAtraumatic, normocephalic, PERRLA, EOMI, arcus senilus bilaterally, conjunctiva and sclera clear, nares patent, nasopharynx clear, edentulous.
Atraumatic, normocephalic, PERRLA, EOMI, conjunctiva and sclera clear; nares patent, nasopharynx clear, good dentition. Piercing in her right nostril and lower lip.
Bulging eyes NeckSuppleDiffuse enlargement of the thyroid glandLungsCTA AP&L
CTA AP&L
CTA AP&LCardS1S2 without rub or gallopS1S2 without rub or gallopS1S2 without rub, TachycardiaAbdpositive bowel sounds (BS) in all four quadrants; no masses; no organomegaly noted; diffuse, mild, bilateral lower quadrant pain noted Mild diffuse tenderness.
- INSPECTION: no masses or thrills noted; no discoloration and skin is warm to; no tattoos or piercings; abdomen is nondistended and round
• AUSCULTATION: bowel sounds (BS) are normal in all four quadrants, no bruits noted
• PALPATION: on palpation, abdomen is tender to touch in four quadrants; tenderness noted on light palpation, deep palpation reveals no masses, spleen and liver unremarkable
• PERCUSSION: tympany heard in all quadrants, no dullness noted in abdominal area
benign, normoactive bowel sounds x 4GU Non contributory• EXTERNAL: mature hair distribution; no external lesions on labia
• INTROITUS: slight green-gray discharge, no lesions
• VAGINAL: normal rugae; moderate amount of green discharge on vaginal walls
• CERVIX: nulliparous os with small amount of purulent discharge from os with positive cervical motion tenderness (CMT)
• UTERUS: ante-flexed, normal size, shape, and position
• ADNEXA: bilateral tenderness with fullness; both ovaries without masses
• RECTAL: deferred
• VAGINAL DISCHARGE: green in color Non contributoryExtno cyanosis, clubbing or edemano cyanosis, clubbing or edemano cyanosis, clubbing or edemaIntegumentgood skin turgor noted, moist mucous membranesintact without lesions masses or rashesThin skin, Increase moistureNeuroNo obvious deformities, CN grossly intact II-XIINo obvious deficits and CN grossly intact II-XIINo obvious deficits and CN grossly intact II-XII
Once you received your case number, answer the following questions:
- What other subjective data would you obtain?
- What other objective findings would you look for?
- What diagnostic exams do you want to order?
- Name 3 differential diagnoses based on this patient presenting symptoms?
- Give rationales for your each differential diagnosis.
Expert Solution Preview
Introduction: In this case, we are presented with three different patients who have gastrointestinal and endocrine symptoms. As a clinician, we need to gather additional subjective data, identify objective findings, order diagnostic exams, and provide a list of differential diagnoses along with rationales.
1. What other subjective data would you obtain?
– We would ask about the duration and frequency of the symptoms, any associated symptoms such as fever, weight loss, or changes in appetite, any recent travel or exposure to infections, dietary habits, bowel habits, menstrual history (for females), and any history of similar symptoms in the past.
2. What other objective findings would you look for?
– We would perform a thorough physical examination, including vital signs, assessment of general appearance, examination of the abdomen for tenderness, organomegaly or masses, examination of the thyroid gland for enlargement or nodules, assessment of bowel sounds, inspection of the eyes for any signs of proptosis, and examination of the skin for any characteristic findings.
3. What diagnostic exams do you want to order?
– Based on the presenting symptoms, some possible diagnostic exams to order may include:
– Stool analysis for ova, parasites, or infectious pathogens.
– Complete blood count and blood smear to check for anemia or any abnormal cells.
– Thyroid function tests, including TSH, free T4, and thyroid autoantibodies.
– Abdominal ultrasound to assess the abdominal organs such as liver, gallbladder, or kidneys, and to evaluate the thyroid gland.
– Pelvic examination and cultures in female patients with vaginal discharge.
4. Name 3 differential diagnoses based on this patient’s presenting symptoms?
– For case 1 (“frequent and watery bowel movements”):
– Infectious gastroenteritis
– Inflammatory bowel disease (e.g., Crohn’s disease, ulcerative colitis)
– Malabsorption syndrome (e.g., celiac disease)
– For case 2 (“pain in the belly”):
– Acute appendicitis
– Irritable bowel syndrome
– Ovarian cyst or torsion
– For case 3 (“neck swelling”):
– Thyroid goiter
– Thyroid cancer
– Thyroiditis (e.g., Hashimoto’s thyroiditis)
5. Give rationales for each differential diagnosis.
– Case 1:
– Infectious gastroenteritis: Loose stools and recent onset suggest an acute infection.
– Inflammatory bowel disease: Frequent loose stools and abdominal pain may indicate chronic inflammation of the gastrointestinal tract.
– Malabsorption syndrome: Chronic diarrhea and weight loss may suggest malabsorption of nutrients, possibly due to celiac disease.
– Case 2:
– Acute appendicitis: Severe abdominal pain with certain triggers is consistent with appendicitis.
– Irritable bowel syndrome: Abdominal pain often relieved by defecation and not associated with any specific triggers may suggest IBS.
– Ovarian cyst or torsion: Pelvic pain can be caused by various gynecological conditions, including ovarian cyst or torsion.
– Case 3:
– Thyroid goiter: Neck swelling and enlarged thyroid gland may indicate a goiter.
– Thyroid cancer: Progressive swelling of the neck warrants consideration of thyroid cancer.
– Thyroiditis: Neck swelling with tenderness and gradual onset could be indicative of thyroiditis, such as Hashimoto’s thyroiditis.
Note: The above answers are general and may vary depending on the specific details provided in the assigned case.
