Case 7

A 26-year-old woman presents for evaluation of 3 months of non-bloody diarrhea. She describes 4-6 loose or watery stools per day, most days of the week, associated with cramping abdominal pain and bloating. She is awoken for a nocturnal bowel movement 1-2 times per week. When symptoms started, she was having 6-8 stools per day, but she had some improvement after starting a fiber supplement. She also reports fatigue but denies any weight loss. She cannot recall anything that seemed to have incited her symptoms. Her diarrhea seems to get worse after fatty foods as well as broccoli and cauliflower. Her other medical history is notable for psoriasis, for which she intermittently uses a topical steroid cream, and anxiety, for which she takes escitalopram. She denies use of non-steroidal anti-inflammatory medications or laxatives. She denies any joint or back pain, other skin lesions, or eye redness. She denies any family history of cancer or inflammatory bowel disease.

Notable Physical Exam Findings:

Vitals: Within normal limits

Abdominal: Soft, nontender, nondistended, normal bowel sounds

What is your differential diagnosis? (pick your top 5)
Irritable bowel syndrome
Functional diarrhea
Small intestinal bacterial overgrowth
Infectious diarrhea
Crohn’s disease
Ulcerative colitis
Microscopic colitis
Inflammatory Bowel Disease Unclassified
Exocrine pancreatic insufficiency
Celiac disease

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