Digestive System Case Study Mr. Pope is complaining of headache, a gnawing epiga
ID: 3517444 • Letter: D
Question
Digestive System Case Study
Mr. Pope is complaining of headache, a gnawing epigastric pain, and diarrhea. His care-provider asks him the following questions
Have you had these symptoms previously?
Response: “Yes but not as bad.”
Are you allergic to any foods
Response: “Shellfish does not like me and milk gives me ‘the runs’”
His care-provider recommends a lactose-free diet.
Why is this diet prescribed? (What differential diagnosis is the doctor working from? How would this diet correct this possible diagnosis?)
Despite the new diet, Mr. Pope’s problems persist. In fact the symptoms and diarrhea get worse and by the end of the next day, he is in severe abdominal pain.
He is asked some more questions to probe his condition. One is whether he has travelled outside the county recently, which he has not, reducing the possibility of Shigella bacteria, which is associated with sanitation conditions.
Do you drink alcohol and how much?
Response: “Little or none.”
Have you recently eaten raw eggs or a salad containing raw eggs at a gathering?
Response: “No”
Do you have acid reflux / heartburn?
Response: ”No”
Are there certain foods that seem to precipitate these attacks?
Response: “Yes, whenever I have a sandwich”
On the basis of these responses, what other differential diagnoses can be ruled out? Why?
What are some possible differential diagnoses that could still be the problem?
What would your diagnosis be at this point? What treatment would you prescribe to the patient?
Explanation / Answer
Answer 1:-
The milk contains lactose. Many adults are lactose intolerant i.e., they lack the enzyme lactase that digests lactose. Thus, the lactose intolerant people develop the gastrointestinal trouble due to indigestion of lactose. Since Mr. Pope told that milk gives him the runs, it is advisable to cut down milk or milk products from the diet. Thus, the lactose free diet is subscribed.
Answer 2:-
The raw egg may contain salmolnella. Salmonella is harboured by chickens and are passed on into the eggs. The Salmonella infection can lead to abdominal pain and loose motions. However, symptoms occur far earlier than the detection of the organism in the body, Salmonella takes two weeks of period to get detected once the symptoms appear. No raw eggs, means possibility of Salmonella infection is ruled out
The acidity option is ruled out as Mr. Pope never suffered from acidity or heartburn.
Answer 3:-
The sandwich eaten by Mr. Pope may contain unwashed vegetables that may act as source of food-borne bacteria or amoeba.
Answer 4:-
The diagnosis can be of bacterial infection of staphylococcus or amoebic dysentery.
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