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LEARNING OBJECTIVES

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After completing this case study, the reader should be able to:

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  • Determine the signs and symptoms of irritable bowel syndrome associated with constipation (IBS-C).

  • Devise patient management strategies for patients with IBS, including pharmacologic and nonpharmacologic options.

  • Recommend parameters for monitoring the safety and efficacy of therapy used in patients with IBS-C.

  • Discuss treatment options for IBS with diarrhea (IBS-D).

  • Evaluate the efficacy of treatment options for patients with IBS.

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PATIENT PRESENTATION

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Chief Complaint

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“My IBS is acting up again. I feel all bloated and I really have to strain to have a bowel movement. I have been really uncomfortable for the past 4 weeks. Most recently, I added Metamucil tablets to the docusate I was already taking because someone in the past told me that I would probably be able to tolerate the tablets better than Metamucil powder. I haven’t seen much improvement in the 8 weeks that I have been using them, plus it is hard to remember to take them three times a day. I have tried to live with this but I really think I need to try something else. Is there anything you can give me?”

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HPI

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Jane Hoffman is a 28-year-old woman who presents to her PCP with the chief complaint of a 7-month history of hard pelletlike stools and difficulty passing stools. She was diagnosed with IBS her freshman year in college. She has been able to tolerate the minimal symptoms until about 8 months ago when she began to notice some bloating and a decrease in the number of bowel movements per week. She states that she now constantly feels bloated and has taken to wearing loose-fitting clothing because she cannot tolerate anything tight around her abdomen. She attributes the worsening symptoms to the stress associated with trying to complete classes for a graduate degree and serving as a TA for two courses. In addition to the 20 hours a week that she serves as a TA, she also works at least two weekends a month in a department store as a sales assistant. She also states the symptoms have gotten worse since she went back to school. In the last 2 years, they have been worse when she has midterms or finals or when she needs to complete a major college writing assignment. Other than stress, she cannot think of anything else that has changed in her life. She does not remember having any gastroenteritis symptoms in the last year, and she dislikes eating yogurt.

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Prior to 8 months ago, she states that she averaged about six stools a week. She estimates that she has had one or two bowel movements a week for the past 6 weeks. She complains of straining to pass her stools and states that she is getting up 60 minutes early in the ...

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