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A 27-year-old female presents to your clinic complaining of abdominal pain since yesterday. She rates it as 5 on a scale of 1-10 and reports that it is mostly dull and crampy. She thinks it is worse in the left lower quadrant. She denies any significant past medical history or family history. She has had no surgeries and is taking no medications. Her last menstrual period was 25 days ago and she has regular periods every 28 days. She is married and denies smoking or drinking. Her review of systems is positive for straining with bowel movements, but she denies bloody stools, fever, nausea, vomiting, or recent travel. She also denies urinary or vaginal symptoms.
On physical examination, her vital signs are normal and her BMI is 41 kg/m2 (or 1 Iowa Unit, as we say in the Midwest). Her cardiopulmonary exam is normal, and she has good bowel sounds. She has vague tenderness in the left lower quadrant but no rebound tenderness or guarding. Also, you note firmness there. Her femoral pulses palpate equally well. Her pelvic exam reveals no discharge or tenderness, and her rectal exam reveals hard stool that is guaiac-negative. Urine studies are negative and she is not pregnant; a CBC is normal.
What is the MOST appropriate step now? |
| | A) | Abdominal CT. |
| | B) | Serum electrolytes. |
| | C) | Complete bowel rest. |
| | D) | Reassurance and treatment of constipation. |
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2 | |
Which of the following principles guide the management of constipation? |
| | A) | Increased fluid and fiber intake. |
| | B) | Increased exercise. |
| | C) | Routine defecation times. |
| | D) | Judicious use of laxatives. |
| | E) | All of the above. |
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3 | |
Remembering that your patient has no organic cause of constipation identified, which of the following medications would be LEAST appropriate to institute at this time? |
| | A) | Senna. |
| | B) | Polyethylene glycol (Miralax). |
| | C) | Docusate sodium (Colace). |
| | D) | Sorbitol. |
| | E) | Psyllium (Metamucil). |
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