IHUMAN KAREN FLOYD ABDOMINAL PAIN CASE STUDY GRADED A+ LATEST VERSIONS 2025., Exams of, Exams of Integrated Case Studies

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IHUMAN KAREN FLOYD ABDOMINAL PAIN

CASE STUDY GRADED A+ LATEST

VERSIONS 2025., Exams of

Nursing"Chronic Abdominal Pain in a 45-

Year-Old Female: A Case of IBS-M"

• Dietary Habits : Irregular meals due to long work hours; occasional meal skipping
• Menstrual History : No significant changes noted
• Weight Changes : No recent weight loss
• Family History : Denies family history of inflammatory bowel disease (IBD) or colorectal cancer(nursinghero.com, coursehero.com, docsity.com) Physical Examination
• General Appearance : Well-nourished, alert, and oriented
• Abdominal Inspection : Flat and symmetric; no scars or lesions
• Auscultation : Normal bowel sounds
• Palpation : Mild tenderness upon deep palpation in the lower abdomen; no rebound tenderness or guarding

• Rectal and Pelvic Exams : Normal(nursinghero.com, coursehero.com) Differential Diagnosis Considering Karen's symptoms, several conditions should be evaluated:

1. Irritable Bowel Syndrome (IBS) : Characterized by chronic abdominal pain, bloating, and alternating bowel patterns.
2. Celiac Disease : May present with bloating and diarrhea; tissue transglutaminase antibody (IgA- tTG) testing can aid diagnosis.
3. Lactose Intolerance : Could explain bloating and gas; dietary history and hydrogen breath test may be informative.
4. Small Intestinal Bacterial Overgrowth (SIBO) : Consider if symptoms persist despite other treatments; lactulose breath test can confirm.
5. Gastrointestinal Infections : Recent travel or exposure history may suggest infectious

• Dietary Modifications : o Implement a low FODMAP diet to identify and eliminate trigger foods. o Avoidance of lactose-containing products if intolerance is confirmed.
• Pharmacological Interventions : o Antispasmodic agents (e.g., hyoscyamine) for cramping. o Probiotics to support gut flora balance. o Laxatives or antidiarrheal medications as needed for bowel regulation.
• Stress Management : o Incorporate relaxation techniques such as mindfulness or yoga. o Consider counseling or cognitive-behavioral therapy if stress is a significant trigger.
• Follow-Up :

o Schedule a follow-up appointment in 4– 6 weeks to assess symptom progression and treatment efficacy. o Reevaluate diagnosis if symptoms persist or worsen. Certainly! In addition to Irritable Bowel Syndrome (IBS) , Celiac Disease , Lactose Intolerance , and Small Intestinal Bacterial Overgrowth (SIBO) , here are more differential diagnoses to consider for Karen Floyd's chronic abdominal pain: Additional Differential Diagnoses for Chronic Abdominal Pain

1. Inflammatory Bowel Disease (IBD) - Includes Crohn’s disease and Ulcerative colitis - Look for: o Chronic diarrhea, often with blood o Weight loss, fatigue o Elevated CRP/ESR, anemia o Confirmed by colonoscopy with biopsy

• Right upper quadrant pain, especially after fatty meals
• May have history of gallstones or biliary colic
• Ultrasound is the preferred imaging 7. Peptic Ulcer Disease (PUD)
• Epigastric pain, worse on an empty stomach or at night
• May have NSAID use or H. pylori infection
• Upper endoscopy for diagnosis 8. Colorectal Cancer
• May present with change in bowel habits , anemia, unexplained weight loss
• Particularly important if there's a family history or patient is >
• Colonoscopy is key for evaluation 9. Functional Dyspepsia
• Persistent upper abdominal discomfort with no structural disease
• Often worsened by stress or eating
• Diagnosis of exclusion

10. Psychogenic Abdominal Pain / Somatic Symptom Disorder - Consider if physical exam and tests are normal and symptoms persist - May be linked to anxiety, depression, or past trauma - Treat with a biopsychosocial approach Workup Tips for Broad Diagnosis To narrow the list: - CBC → anemia, infection - CRP/ESR → inflammation - Stool studies → infection, occult blood - Endoscopy/Colonoscopy → structural abnormalities - Pelvic/transvaginal ultrasound → gynecologic causes - CT abdomen/pelvis → diverticulitis, masses - Psych evaluation → if functional pain suspected

• ❌ Nocturnal pain/waking from sleep
• ❌ Persistent vomiting
• ❌ Family history of colon cancer or IBD If any of these are positive → Refer for colonoscopy and imaging. Karen: No red flags reported ➡ **Continue conservative workup.

3. Basic Labs and Tests Test Purpose Expected Findings (if IBS)** CBC Rule out anemia, infection Normal CMP Assess liver, renal function Normal CRP/ESR Inflammation marker (IBD, infection) Normal TSH Hypothyroid-related GI issues Normal

Test Purpose Expected Findings (if IBS) Celiac Panel (IgA-tTG) Rule out celiac disease Negative Stool studies (OVA, culture) Rule out infection or parasites Negative

4. Functional vs Structural Pathology If labs are normal and symptoms align with IBS If labs are abnormal or inconsistent Trial low FODMAP diet , antispasmodics, probiotics Proceed to colonoscopy , abdominal US , CT Consider psychological stress , anxiety contributing Check for **IBD, cancer, diverticulitis, ovarian mass

5. Additional Focused Evaluation If Needed** Concern Next Test Persistent bloating/gas SIBO breath test

1. Lifestyle & Dietary Modifications These are first-line for managing IBS: Low FODMAP Diet

• Avoid fermentable carbs (e.g., onions, garlic, beans, dairy, apples, wheat)
• Reintroduce slowly under dietitian guidance to identify triggers Increase Fiber Intake
• Use soluble fiber (e.g., psyllium) rather than insoluble (e.g., bran)
• Helps regulate both constipation and diarrhea Regular Meals & Hydration
• Avoid skipping meals
• Drink 6–8 glasses of water daily
• Limit caffeine, carbonated drinks, and alcohol 2. Medications Adjust based on predominant symptom (diarrhea, constipation, or pain):

Abdominal Pain/Cramping

• Antispasmodics : o Hyoscyamine (Levsin), Dicyclomine (Bentyl)
• Tricyclic antidepressants (low dose): o Amitriptyline 10–25 mg at bedtime (helps pain & gut motility) Diarrhea
• Loperamide (Imodium) PRN or scheduled for control
• Rifaximin : Antibiotic for IBS-D or SIBO (short course)
• Bile acid binders (if bile acid diarrhea suspected): Cholestyramine Constipation
• Osmotic laxatives : PEG 3350 (Miralax)
• Lubiprostone or Linaclotide : For severe cases Bloating/Gas
• Simethicone (Gas-X)
• Trial of probiotics (e.g., Bifidobacterium infantis)

• Reassure that IBS is chronic but manageable
• Encourage food/symptom diary
• Educate on avoiding unnecessary antibiotics or laxatives
• Discuss realistic expectations — may take weeks to see results Here's a full SOAP note for Karen Floyd’s IBS-M case , appropriate for a nurse practitioner or medical provider: SOAP Note – Karen Floyd S – Subjective CC : “I’ve been having off-and-on stomach pain for years.” HPI : Karen Floyd is a 45-year-old female presenting with a 10-year history of intermittent lower abdominal pain described as cramping and bloating. Pain is often relieved by bowel movements and worsens with certain foods (rich/fatty) and stress. She reports

alternating constipation and diarrhea. Denies blood in stool, weight loss, vomiting, fever, or nocturnal symptoms. ROS :

• GI : +Abdominal pain, +bloating, +gas, +constipation, +diarrhea
• Constitutional : Denies fever, chills, weight loss
• GU : Denies dysuria, hematuria
• Neuro/Psych : Reports work-related stress; denies depression or anxiety
• Menstrual : Normal menses, no pelvic pain PMH : No significant chronic illnesses PSH : None Meds : Occasional OTC loperamide Allergies : NKDA Family Hx : No IBD, colorectal cancer Social Hx : Works full-time, high stress, irregular meals, no tobacco, occasional alcohol O – Objective Vitals :