# Differencial Diagnosis Help



## Acidian (Jan 23, 2008)

Could you help me with ideas for what this patient has? Our consultant asked us to take her History and come up with a few options.

19 year old, female patient. Obese.

Presenting Complaint:
"Heart burn" felt daily for the past 2 weeks. Including waking up at night with heart burn.

History of Presenting complaint:
Started 2 weeks ago
Wakes up about 3 times a week with heart burn.
No change in frequency of opening bowels
Increased Flatus.
Infrequent L sided loin region abdominal pain

Drug History:
Maalox Plus: Magnesium Hydroxide - Aluminum Hydroxide - Simethicone

Family History:
Mother: HT
Father: Duodenal Ulcer

Social History:
Lives at home with parents
non smoker 
no alcohol

Allergies
Noprilam (but not Augmentin)

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I am thinking maybe
An Ulcer
Irritable Bowel syndrome

Anything else? 
Anyone agrees with the above 2 options?

Thank you.


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## shizopherinic (Dec 2, 2009)

It is not mentioned in the history that whether the pain relieves with taking meal or not.


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## Acidian (Jan 23, 2008)

shizopherinic said:


> It is not mentioned in the history that whether the pain relieves with taking meal or not.


Not sure about that. This is a real patient I took a history from. 
Let me ask the other people in my group maybe somebody actually has the answer.

Pain is not constant.
Sometimes the pain is occurs/increases on straining when trying to pass stools.

Also the acid reflux and increased flatus tends to occur after meals.


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## Acidian (Jan 23, 2008)

More info

Had 1 episode of exploding diarrhea (which was described the "chocolate porridge" consistency)
Does not seem to get better after meals.
Generally feels better after passing stools but sometimes patient feels as if she has not completely emptied bowels


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## MastahRiz (Jan 26, 2006)

GERD + one of the following: IBS, UC, GI TB, Crohn's Disease, giardiasis.

Any physical examination findings to go with that history? A dietary history may also be of some relevance here.


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## Acidian (Jan 23, 2008)

Patient did not want us to touch her (don't ask why).
We asked the doctor. He said she had no tenderness. Bowel Sounds where present and no masses were felt.


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## arsakoy (Jul 22, 2010)

Your patient could have Mentriere's disease or Zollinger Elison's disease.


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