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Questions to ask the Patient
I would pose subjective questions to the patient about other symptoms such as abdominal pain, indigestion or heartburn, diarrhea, nausea or vomiting, blood in stool or constipation. I will also enquire from the patient if there are any allergic reactions elicitedafter eating, for example itching, rashes, or hives that would help identify presence of food allergy. It is also important to ask the patient if she has difficulties, urinating as this would be a sign of abdominal mass. Obtain her medical history information including illnesses and past injuries. Reviewing all her previous supplements and medications will help determine if they are the causal agents of her symptoms.
A comprehensive physical examination should be conducted since the symptoms occur in numerous body systems. Carefully assessthe oral sores and skin to observe for any rashes. Perform the Gastrointestinal examination thoroughly to identify the patient’s abdominal distention features. Sullivan and Norman (2012) explain that symmetrical distention may be due to gas or obesity while asymmetrical distention may be as a result of hernia, bowel obstruction, or a tumor. The patient also needs a pelvic assessment to ensure absence of uterine enlargement and palpable masses. Additionally, conduct a psychiatric examination to determine whether anxiety, stress or depression is related to the symptoms.
The patient is most probably suffering from Celiac disease. Some of the common signs and symptoms of Celiac disease in adults are: fatigue, abdominal bloating, gas, nausea, abdominal pain, vomiting, diarrhea, constipation and weight loss. Furthermore, nearly half of celiac disease patients also experience symptoms that are not related to the gastrointestinal system such as fatigue, tingling in the legs and hands, anemia, oral lesions, skin rash and weight loss (Mayoclinic, 2019). The other likely differential diagnosis would be Irritable Bowel Syndrome (IBS). According to Barratt et al. (2011), IBS is more prevalent in the general population than Celiac disease and about 29% of people diagnosed with Celiac disease have IBS. This implies that the patient has either one of the conditions or both at the same time.
Blood tests such as complete blood count would be done to identify infections or anemia. Perform a Complete Metabolic Panel to asses for dehydration and electrolyte imbalance. Moreover, checking the level of vitamin D determines whether it’s contributing to the patient’s fatigue. To ascertain that the patient is suffering from Celiac disease, I would conduct a serological test, which detects the disease early; it also limits the prodrome period, which avoids additional harm to the villi (NIDDK, 2016). Moreover, leukocyte antigens genetic testing for humans can confirm absence of celiac disease. If the tests confirm the presence of celiac disease, then ordering an endoscopy and biopsy would help to observe the intestines and damage caused to villi.
Since celiac disease does not have a cure, the main treatment would be avoiding gluten, which is the causing factor. When the patient is confirmed positive for the disease, I would guide her on taking gluten free diets, which would help reduce the symptoms gradually thereby managing the disease. Referring the patient to a dietician will help her transition smoothly from diets with wheat and gluten. I would also have her attend regular follow-ups to assess her body’s response to the gluten-free diets.