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Old 05-20-2013
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Default gastroenterology q10 I B D

A 29-year-old woman comes to see you in the clinic because of abdominal discomfort. She feels abdominal discomfort on most days of the week, and the pain varies in location and intensity. She notes constipation as well as diarrhea, but diarrhea predominates. In comparison to 6 months ago, she has more bloating and flatulence than she has had before. She identifies eating and stress as aggravating factors, and her pain is relieved by defecation.
You suspect irritable bowel syndrome (IBS). Laboratory data include white blood cell (WBC) count 8000/μL, hematocrit 32%, platelets 210,000/μL, and erythrocyte sedimentation rate (ESR) of 44 mm/h. Stool studies show the presence of lactoferrin but no blood. Which interven-tion is appropriate at this time?

A. Antidepressants
B. Ciprofloxacin
C. Colonoscopy
D. Reassurance and patient counseling
E. Stool bulking agents
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Old 05-20-2013
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Originally Posted by cingulate.gyrus View Post
A 29-year-old woman comes to see you in the clinic because of abdominal discomfort. She feels abdominal discomfort on most days of the week, and the pain varies in location and intensity. She notes constipation as well as diarrhea, but diarrhea predominates. In comparison to 6 months ago, she has more bloating and flatulence than she has had before. She identifies eating and stress as aggravating factors, and her pain is relieved by defecation.
You suspect irritable bowel syndrome (IBS). Laboratory data include white blood cell (WBC) count 8000/μL, hematocrit 32%, platelets 210,000/μL, and erythrocyte sedimentation rate (ESR) of 44 mm/h. Stool studies show the presence of lactoferrin but no blood. Which interven-tion is appropriate at this time?

A. Antidepressants
B. Ciprofloxacin
C. Colonoscopy
D. Reassurance and patient counseling
E. Stool bulking agents
The patient has a high ESR, Low hematocrit and high stool lactoferrin... 2 things can cause this.. either a chronic bacterial infection (only bacteria increase stool lactoferrin when causing inflammatory diarrhea) or inflammatory bowel disease... namely crohn or UC... only way to differentiate will be via colonoscopy
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Old 05-20-2013
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Originally Posted by XpaezX View Post
The patient has a high ESR, Low hematocrit and high stool lactoferrin... 2 things can cause this.. either a chronic bacterial infection (only bacteria increase stool lactoferrin when causing inflammatory diarrhea) or inflammatory bowel disease... namely crohn or UC... only way to differentiate will be via colonoscopy

U r correct...

The answer is C.

Although this patient has signs and symptoms consist-ent with IBS, the differential diagnosis is large. Few tests are required for patients who have typical IBS symptoms and no alarm features. In this patient, alarm features include anemia, an elevated ESR, and evidence of WBCs in the stool. Alarm features warrant further investigation to rule out other gastrointestinal disorders such as colonic pathology including diverticular disease or inflammatory bowel disease. In this case, colonoscopy to evaluate for luminal lesions and mucosal characteristics would be the logical first step.
At this point, with the warning signs, empiric therapy for IBS is premature. Reassurance, stool bulking agents, and antidepressants are all therapies to consider if a patient does indeed have IBS.
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