A young girl presents with abdominal pain and a recent change in bowel habit, with passage of mucus in stool. There is no associated blood in stool and symptoms are increased with stress. The most likely diagnosis is.
Answer is A (Irritable bowel syndrome) Stress related increase in abdominal pain with change in bowel habit and passage of mucus in stool, together with absence of 'red flag' signs such as blood in stool in a 'young female' suggest a diagnosis of Irritable bowel syndrome. Young age and Female sex are epidemiological risk factors for lBS "Younger people have a higher prevalence of lBS in the community" Although IBS may affect all ages most patients have their onset of symptoms before age of 45. Older people have a lower rate repoing frequency and onset in patients > 50 years of age is a 'Red Flag' sign that may suggest the possibility of another disease `Women are diagnosed two or three times as often as men and make up 80% of the population with severe IBS' - Harrison 17th/1899 Onset of symptoms in periods of stress suppo a diagnosis of IBS. Onset of symptoms in periods of stress or emotional upset are suggestive of IBS' - IBS is charachteristically associated with absence of blood in stool Presence of blood in stool is a 'Red Flag 'sign that suggests possibility of another disease.- "Red flag" conditions in irritable bowel syndrome that suggest possibility of another disease Presence of any of the following calls lbr fuher investigation to rule out other disease processes: Fever Blood in stools Nocturnal pain Abnormal physical findings Onset in patients> 50 years of age Weight loss or anorexia Anemia Abnormal blood studiesFamily history of inflammatory bowel disease or malignancy Abdominal pain with change in bow el habit together with passage of mucus in stool (in the absence of 'Red Flag' signs) suppos a diagnosis of IBS Symptoms that cumulatively suppo the diagnosis of Irritable Bowel Syndrome: Abnormal stool frequencyQ (for research purposes, "abnormal- defined as > 3 bowel movements/week) Abnormal stool fOrmationQ (lumpy/hard or loose/watery stool) Abnormal stool habitsQ (straining, urgency, or feeling of incomplete evacuation) Passage of mucusQ Bloating or feeling of abdominal distention
Irritable bowel syndrome
Ulcerative Colitis
Crohn's disease
Amebiasis