In week 3 you learned about other common adolescent health conditions.  Review the following case study and answer the following questions: An 18 year old white female presents to your clinic today with a 2 week history of intermittent abdominal pain.  She also is positive for periodic cramping and diarrhea as well as low grade fever.  She also notes reduced appetite. She notes that She admits smoking ½ PPD for the last 2 years. Denies any illegal drug or alcohol use. Does note a positive history of Crohn’s Disease.  Based on the information provided answer the following questions: What are the top 3 differentials you would consider with the presumptive final diagnosis listed first? What focused physical exam findings would be beneficial to know? What diagnostic testing needs completed if any to confirm diagnosis? Using evidence based treatment guidelines note a treatment plan. Submission Details: Post your response to the Discussion Area by the due date assigned. Respond to atleast two posts by the end of the week.

ADDITIONAL INFORMATION;

Introduction

The term “intermittent abdominal pain” is used to describe discomfort or pain that comes and goes. Intermittent abdominal pain can also be referred to as intermittent lower abdominal pain, upper abdominal cramps, or lower back aches. In most cases of intermittent abdominal pain, the discomfort lasts for less than three months and seems to be caused by one of several possible causes.

Intermittent abdominal pain is pain that comes and goes over a period of time.

Intermittent abdominal pain is pain that comes and goes over a period of time. It’s different from the regular, ongoing belly aches you get when you eat too much or drink too much alcohol.

If your intermittent abdominal pain is mild, it may just be something minor like gas or bloating. If it’s more severe, it could be related to irritable bowel syndrome (IBS). If your intermittent abdominal pain is sudden in nature and lasts for several hours at a time, but doesn’t happen daily, this might be an episode of gastroesophageal reflux disease (GERD). Other possible causes include:

• Leaky gut syndrome

• Celiac sprue disease

There are many possible causes of intermittent abdominal pain, including:

• Ulcers

• IBS (irritable bowel syndrome)

• Muscle strain

• Stomach flu

• Pregnancy—commonly known as “morning sickness”—is the cause of intermittent abdominal pain in women. It can also be associated with nausea, vomiting and diarrhea. In some cases, it may be accompanied by bloating or gas. The severity of each episode varies from person to person depending on many factors including age, ethnicity and overall health status.* Kidney stones have been known to cause abdominal discomfort due to their location near the spine; however they are rare enough that they shouldn’t be considered as a direct cause for your symptoms.* If you’re experiencing any type of chronic pain that is not relieved by medical treatment or non-steroidal anti-inflammatory drugs (NSAIDs), see your doctor immediately so they can rule out other causes like irritable bowel syndrome (IBS).

Ulcers

Ulcers are sores or ulcerations on the mucous membranes, including the lining of the mouth and esophagus. They’re caused by bacteria or viruses that live in your digestive tract and can become inflamed as they react to stress or other factors.

You’re more likely to get an ulcer if you smoke cigarettes or drink alcohol frequently because these substances increase your risk for developing one. But even if you don’t smoke tobacco products, drinking too much alcohol may still increase your chances of getting an ulcer because it can lead to dehydration—a condition that increases inflammation in the body—and weaken its defenses against infection.

Irritable bowel syndrome (IBS)

Irritable bowel syndrome (IBS) is a common digestive disorder that can cause pain, bloating and diarrhea. It affects up to 25 percent of people at some point in their life.

IBS is not considered a serious condition but it can be very uncomfortable, particularly when you have IBS constipation or diarrhea.

If you have symptoms such as:

• Painfull cramping in your stomach area

• Bloating after meals with gas bubbles forming inside the abdomen (this may feel like air coming out of your stomach)

Muscle strain

Muscle strain is a common cause of intermittent abdominal pain. It can occur when you lift heavy objects or overexert yourself, such as in sports. Muscle strains often heal within a few days, but they may take longer if you have a severe case.

Muscle strains usually occur between the muscle and bone (the fascia), so there’s no bruising or bleeding from the injury; however, your doctor will examine your abdominal region to make sure no organs are impacted by this type of injury. In some cases, muscle strains can result in internal bleeding and require surgery to repair damaged tissue.

Stomach flu

The symptoms of stomach flu are similar to those of a cold, but may include:

• Nausea, vomiting and diarrhea (usually within 24 hours)

• Fever higher than 101 degrees Fahrenheit (38 degrees Celsius) or lower than 96 degrees Fahrenheit (36 degrees Celsius)

If you have these symptoms, it’s important to see your healthcare provider as soon as possible. If you’re sick enough that you can’t keep anything down and need medical care, then call 911 or go directly to the emergency department at your local hospital.*

Pregnancy

Pregnancy is a common cause of intermittent abdominal pain. Other symptoms include nausea and vomiting, breast tenderness, fatigue, and mood changes. These symptoms usually begin about 2 weeks after conception. Pregnant women should see their doctor if they have any signs or symptoms that worry them such as:

• Irregular periods (menstrual irregularities)

• Severe morning sickness (vomiting during the first trimester)

• Abdominal bloating or swelling

Kidney stones

Kidney stones are hard, solid deposits that form in the kidneys. There are many different types of kidney stones, but they all have one thing in common: they’re really painful!

Kidney stones can cause pain in the back, side or groin. Some people experience pain when urinating as well. If you have a kidney stone lodged near your bladder and it’s causing intense pressure to build up behind it (or if you’ve had one removed), this could be why you feel so miserable at times—even though there’s no obvious reason why that would happen other than a stone forming inside your body!

Intermittent abdominal pain can have many possible causes.

• Infection

• Dizziness, vertigo and/or imbalance

• Abdominal distension, bloating and gas

• Bloating after eating (possibly caused by a change in your diet)

Conclusion

Intermittent abdominal pain is something that can be very disabling, and it can also lead to other serious health problems. If you have intermittent abdominal pain, one of the best things you can do is see your doctor. In most cases, there are simple treatment options that will help get you back on track with your daily life.