PD: CONSTIPATION

University of Northern Philippines. April 23, 2022 5:30 P.M..

[Audio] ex. The patient is a 68 year old woman who complains of a significant change in bowel movements during the past 6 weeks. She describes her bowel movements as being regular, once per day, up until 6 weeks ago. For the past 6 weeks she experienced 3- 4 day periods of constipation.

[Audio] 2 weeks PTC, patient complained of constipation and abdominal pain that is dull and crampy prominently on left lower quadrant with a pain scale of 5/10 that improves after defecation. Patient claimed that she also feels bloated whenever she has constipation. he experiences constipation every 3- 4 days. She was able to pass flatus, however, claimed to have only 2 bowel movements per week and her constipation was relieved only by taking Bisacodyl ( Dulcolax) 5mg tablet as laxative. She described her stool as brown, hard, dry, lumpy, pellet-like, and odorless. She also did not see any blood or mucus on her stool. Fecal incontinence and sensation of incomplete stool evacuation is also present. Patient sometimes needs to press around her rectum with her fingers in order to move her bowels. Patient claimed that her abdominal pain worsens when she strains while defecating. She claimed that she tried drinking herbal tea and ate high fiber foods but those weren't effective. 4 days PTC, patient was nauseous and has decreased appetit.

PAST MEDICAL HISTORY. SCREENING TEST. Breast Ultrasound (August 2020) Result: Benign Mass.

PERSONAL AND SOCIAL HISTORY. Non smoker / drug user Beverage drinker: every 2 weeks, 1-2 bottles Educational Attainment: College Graduate Occupation: Post-graduate student Personal Interest: Playing with her dogs, reading stuffs online, watching movies and documentaries Daily routine : Attends online class the whole day Diet: rarely eat fruits and sometimes forget to drink water Breakfast - usually coffee only, sometimes rice and hotdog/chicken nuggets/canned goods Lunch - meat sometimes w small vegetables Merienda - lately softdrinks/pancit canton/sweets Dinner - meat / fish Vitamins - 2 tab Kirkland Calcium Citrate, Magnesium, and Zinc with Vit D3 daily.

General (-) Fever Skin (-) Rash (-) Itching (-) Dryness HEENT (-) Headache (-) Visual loss or disturbance (-) Hearing loss (-) Dry mouth (-) Metallic taste Gastrointestinal (+) Nausea (-) Vomiting (+) Decreased appetite (+) Irregular bowel movements (+) Painful defecation (+) Incomplete stool evacuation , Hard, dry, lumpy, small or pellet-like stool (+) < 3 stools/weeks (+) Abdominal pain 5/10. (+) Crampy abdomen (+) Abdominal pain prominent in the left lower quadrant (-) Heartburn Neck (-) Swollen glands and lymphadenopathy (-) Neck stiffness Urinary (-) Frequency of urination (-) Dysuria (-) Flank pain Musculoskeletal (-) Back pain, (-) Leg weakness Psychiatric (-) Depression.

Cardiovascular: RRR without murmur or rub Breasts - deferred Abdomen: (-) rashes, (-) bruises, (-) scars/striae, normoactive bowel sounds, (-) abdominal bruit, abdomen generally tympanitic, (+) distended , no tenderness on superficial and deep palpation and no masses palpated, no rebound, rigidity, or guarding, no hepatosplenomegaly Genitalia - deferred Anus / rectum - deferred Extremities: No CCE, pulses 2+ throughout Musculoskeletal: No swelling or joint deformities, full range of motion in all joints of the upper and lower extremities Neurologic: DTRs 2+ throughout; 5/5 strength; (-) atrophy and involuntary movement, responsive to stimuli, normal gait and posture.

SALIENT FEATURES. 25/F Post-Grad Student awake and oriented >> BP: 120/80, HR: 98bpm, RR: 16 breaths/min, Temp. 36.5 °C beverage drinker 2 weeks PTC : constipated with abdominal pain brown, hard, dry, small, pellet-like stools (-) mucus / blood/ water tried banana, juice and bisacodyl 4 days PTC: nauseous & decreased appetite bowel movement 2 stools/week abdomen distended and with dull, crampy pain (LLQ) - relieved by defecation straining and experience painful and prolonged defecation sense of incomplete stool evacuation Patient does manual facilitation/press around her rectum to move bowels flatulence no travel history.

Abdominal pain for atleast 3 days in a month for last 3 three months (chronic) associated with - pain relieved by defecation - change in frequency of stool - change in form of stool Change in frequency of bowel movements Clear or white mucorrhea Nausea Dyspepsia, Heartburn Urinary frequency/urgency Flatulence, Lactose intolerance Without known pathology, possibly from change in intestinal bacteria (Bates).

SIGNS&SYMPTOMS Nausea Abdominal pain Painful and prolonged defecation Bloating Decreased appetite LIFESTYLE CHANGES Low intake of high fiber foods and water Lack of regular exercise Stress.