IRRITABLE BOWEL SYNDROME

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 This is an online e log book to discuss our patient de-identified health data shared after taking his / her / guardians signed informed consent. Here we discuss our individual patients problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problem with collective current best evident based input.

This E blog also reflects my patient centered online learning portfolio and your valuable inputs on the comment box is welcome.

I have been given this case to solve in an attempt to understand the topic of " patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with diagnosis and treatment plan. is an online e log book to discuss our patient de-identified health data shared after taking his / her / guardians signed informed consent. Here we discuss our individual patients problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problem with collective current best evident based input.  

 A 26 year old female,housewife,from miryalguda came to medicine department with chief complaints of loose stoolsand generalised weakness from 4 weeks

History of present illness:

Patient was apparently asymptomatic before may 27 , at night 12am ,after having lunch at 9PM and a brisk walk she started having loose stools which is sudden in onset, watery in consistency,type 7 according to Bristol stool chart ,20 times during the next day aggravated by diet and relieved by diet not associated with fever then she went to government hospital ,there she has been subjected to injections as the diarrhea doesn't stop they went to the private practitioners,she stayed in hospital for 2days and subjected medications such as metrogyl,cefixime,normal saline,ringerlactate,pantop,the loose stools have become soft stools but frequency is 10 times per day .

H/o travel 3 days back before the onset of diarrhea to the khammam to visit his brother in law who got electric shock and she stayed in hotel and 2nd day they fought and she fasted that day Next day she has eaten chilli pickle as their family members did.That two days she has passed stools normal in consistency.Theres no similar complaints  in the family and neighbour hood

H/o fever which is intermittent about 2 hours and come backs to a febrile for 1 hour associated with passing loose stools

H/o hallucinations, agitation from 1 week which is intermittent always comes when she tries to sleep and in drowsy condition associated with neck pain which is shooting type not associated with fever

Past history: No h/o diabeteshypertension,asthma and epilepsy

Personal history:

Before illness: she used to wake up at 5 O clock and she has 3 children(4,6,8) ,she made them ready and do breakfast, busy rice with curry is breakfast ,again she does her daily routine activitiesand at 12 she eats lunch and 9 she eats dinner 

General examination: patient is conscious coherent and cooperative oriented to time place and person.

No pallor,icterus,clubbing and lymphadenopathy,edema


Vitals

Temperature :a febrile

Pulse rate:74bpm

Respiratory rate:14cpm

Bp:100/60 in right arm supine position


PAST HISTORY:

Not a known case of hypertension, diabeties mellitus,asthma, epilepsy,TB

*PERSONAL HISTORY:

Diet-mixed 

Appetite-normal

Sleep - inadequate

Bowel and bladder movements- bowel is 10 times daily.bladder movements normal.

Habits- no addictions

*FAMILY HISTORY:

No similar complaints in the family members.

*GENERAL EXAMINATION:

Patient is conscious coherent and cooperative.

Well oriented to time place and person.

Moderately build and moderately nourished.

Pallor -absent 




Icterus -absent

Cyanosis- absent

Clubbing- absent

Lymphadenopathy- absent

Edema- absent 

VITALS:

Temp- 98°F

RR- 16cycles per min

Bp- 100/60mmHg

PR- 83bpm

*SYSTEM EXAMINATION:

Abdominal examination- tenderness in right iliac ,right lumbar and umbilical regions.

Respiratory system-inspection- trachea central,normal respiratory movements,normal vesicular breath sounds.

Cardio vascular system- S1 ,S2 heard ,no murmurs

CNS Examination- no focal neurological deficits.

*INVESTIGATIONS:








SEROLOGY: HIV ,ELISA NEGATIVE
PROVISIONAL DIAGNOSIS: Irritable bowel syndrome
TREATMENT:
REASSURANCE
LOPERAMIDE 4mg 4 times aday
cholestyramine resin
probiotics
DISCUSSSION: As the patient correlates with rome 4 criteria
recurrent abdkminal pain at least 1 day per week in the last 3months associated with related with defecation, associated witba change in frequency of stool , associated with change in form of stool.
PATIENT LEFT AGAINST MEDICAL ADVISE

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