[44M] Experiencing constipation, stomach pains, and vomiting

Abdominal Pain and Constipation

Differential diagnosis

• Given the patient's history of partial colectomy, the most likely causes of his symptoms are postoperative adhesions (K66.0), small bowel obstruction (K56.6), or constipation due to decreased motility (K59.00).
• Other possible causes include gastroenteritis (K52.9), peptic ulcer disease (K27.9), and gallstones (K80.20).

Plan

Perform a physical examination focusing on the abdomen. Order a complete blood count (CBC), comprehensive metabolic panel (CMP), and abdominal X-ray to assess for possible obstruction or other abnormalities. If these tests are inconclusive, consider ordering an abdominal CT scan or ultrasound.

For symptom management, recommend a high-fiber diet and increased fluid intake to help with constipation. If necessary, consider prescribing a stool softener or laxative.

Vomiting and Loss of Appetite

Differential diagnosis

• The most likely causes of these symptoms are gastroenteritis (K52.9), peptic ulcer disease (K27.9), and gastroparesis (K31.84), which can be a complication of diabetes.
• Less likely but possible causes include pancreatitis (K85.9), cholecystitis (K81.9), and liver disease (K76.9).

Plan

Order a complete blood count (CBC), comprehensive metabolic panel (CMP), and liver function tests (LFTs) to assess for possible liver disease or pancreatitis. If these tests are inconclusive, consider ordering an abdominal ultrasound or endoscopy.

For symptom management, recommend small, frequent meals and avoiding foods that exacerbate symptoms. If necessary, consider prescribing an antiemetic for nausea and vomiting.

Monitor the patient's blood glucose levels closely given his recent diagnosis of type 2 diabetes and current symptoms. Consider referring the patient to a dietitian for further dietary management.