Irritable Bowel Syndrome

Chapter 38 Irritable Bowel Syndrome




Clinical Case Problem 1: A 40-Year-Old Woman with Chronic Constipation and Abdominal Pain


A 40-year-old woman comes to your office with a several-year history of lower abdominal pain associated with constipation (one hard bowel movement every 3   days) and frequent mucous discharge. She states that her abdominal pain is better after a bowel movement. She has never passed blood per rectum. She describes no fever, chills, weight loss or gain, jaundice, or any other symptoms. There is no relationship between the abdominal pain and specific food intake.


On physical examination, the abdomen is scaphoid, and no hepatosplenomegaly or masses are palpated. There is a mild generalized abdominal tenderness, but it does not localize.



Select the best answer to the following questions




1. What is the most likely diagnosis in this patient?


a. hypothyroidism

b. Crohn disease

c. ulcerative colitis

d. lactose intolerance

e. irritable bowel syndrome

2. Which of the following statements regarding the condition described is false?


a. the typical location of the abdominal pain is the lower abdomen

b. intermittent diarrhea can be seen in this condition

c. there is often a perception of incomplete emptying of the rectum

d. bowel movements are often irregular

e. severe abdominal tenderness is a hallmark of the disease

3. Which treatment would be least helpful for this patient?


a. methylcellulose

b. psyllium fiber

c. alosetron (Lotronex)

d. peppermint oil capsules

e. guar gum

4. Which of the following would be most unlikely in a patient with the condition described?


a. family history of this condition

b. increased pain at times of stress

c. pain on awakening from sleep

d. abdominal bloating

e. increased passage of flatus

5. Which of the following tests is not indicated for this patient?


a. complete blood count

b. liver function tests

c. electrolytes

d. abdominal ultrasound

e. thyroid function studies


Clinical Case Problem 2: A 34-Year-Old Woman with Crampy Abdominal Pain


A 34-year-old woman presents with a long history of crampy abdominal pain that is relieved by defecation. She normally has three to five loose but formed stools per day. When she is stressed, she has increased abdominal pain, flatus, and bowel movements. Also, she reports worsening of her symptoms with intake of dairy products. She was recently promoted at work and is excited about her job but is intimidated by her new boss. For the past 3   days, she has called in sick for work and is at your office requesting a note for work. She denies fever, nausea, vomiting, bloody stool, and weight loss. She does not drink alcohol or caffeine, and she does not smoke cigarettes. Her family history is significant for her mother’s having a “sensitive stomach.”



6. What treatment would be least helpful in this patient?


a. alprazolam

b. dairy-free diet

c. probiotics

d. loperamide

e. hyoscyamine

7. Which of the following conditions (symptoms) is not associated with the condition?


a. fibromyalgia

b. cholelithiasis

c. interstitial cystitis

d. depression

e. migraine headaches

8. What specialized testing may be indicated in the described patient?


a. antigliadin antibody

b. stool culture

c. computed tomography (CT) of abdomen and pelvis

d. urea breath test

e. antimitochondrial antibody

9. Which of the following is the most important component of management of the condition described?


a. single-agent pharmacologic therapy

b. multiple-agent pharmacologic therapy

c. a therapeutic physician-patient relationship

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Oct 1, 2016 | Posted by in GENERAL SURGERY | Comments Off on Irritable Bowel Syndrome

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