[63F] Experiencing abdominal pain, fatigue, and other symptoms

Patient Description

A 63-year-old female reports persistent fatigue, significant unintentional weight loss, and constant abdominal pain with associated low back pain. She experiences fatigue that is constant and severe, leading to difficulty focusing and confusion, without relief. The fatigue has been present for approximately two months, and the patient works long 12-hour shifts. Abdominal pain is almost constant, varying between pressure and sharpness, and worsens before bowel movements. The pain is rated 6/10 in severity and has been ongoing for three months. The patient also describes dull, throbbing back pain around the hips on both sides, rated 5/10, persisting for three months. Headaches resembling migraines affect the temples and occipital area, with an intensity of 8/10, occurring intermittently over a couple of months. Diarrhea is frequent, occurring four to five times daily, sometimes with hard stool pieces, and has been a concern for three months. Constipation is less frequent, with hard stools a couple of times a week. The patient has also noted night sweats and swelling and soreness in the back of the neck, starting two months ago. There is no fever, but the patient has had infrequent black stools. No recent injuries, travel, or changes in urine color were reported. The patient has a history of high blood pressure, diagnosed seven years ago, and is currently taking Atenolol 100 mg daily. No known drug allergies or other medications were reported.

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Arora's Assessment

What might be happening

Based on the information you provided, the following conditions may be causing your symptoms:

  • Irritable Bowel Syndrome (IBS): This is a common disorder that affects the large intestine and can cause abdominal pain, bloating, gas, diarrhea, and constipation. The exact cause is unknown, but several factors play a role including muscle contractions in the intestine, abnormalities in the nervous system, inflammation in the intestines, severe infection, or changes in bacteria in the gut.

    • Treatment typically involves lifestyle changes such as changes in diet and exercise, as well as medications to manage symptoms.
  • Chronic Fatigue Syndrome (CFS): This is a complicated disorder characterized by extreme fatigue that can't be explained by any underlying medical condition. The fatigue worsens with physical or mental activity, but doesn't improve with rest. The cause of chronic fatigue syndrome is unknown, although there are many theories — ranging from viral infections to psychological stress.

    • Treatment typically involves a combination of medications to control symptoms, and therapy to help manage the impact of the condition on daily life.
  • Hypothyroidism: This is a condition in which your thyroid gland doesn't produce enough of certain crucial hormones. Hypothyroidism may not cause noticeable symptoms in the early stages, but over time, untreated hypothyroidism can cause a number of health problems, such as obesity, joint pain, infertility and heart disease.

    • Treatment typically involves daily use of the synthetic thyroid hormone levothyroxine, which restores adequate hormone levels, reversing the signs and symptoms of hypothyroidism.
  • Migraines: Migraines are a type of headache characterized by severe throbbing pain or a pulsing sensation, usually on one side of the head. It's often accompanied by nausea, vomiting, and extreme sensitivity to light and sound. Migraine attacks can last for hours to days, and the pain can be so severe that it interferes with your daily activities.

    • Treatment is aimed at preventing a full-blown attack, and alleviating the symptoms that you're experiencing.

Please note that these are potential explanations for your symptoms, and it's important to consult with a healthcare provider for an accurate diagnosis.

What you can do

  1. Make an appointment with your primary care provider to discuss your symptoms. They may refer you to a specialist, such as a gastroenterologist or endocrinologist, depending on your symptoms.
  2. Keep a symptom diary. This can help you and your healthcare provider identify patterns and triggers for your symptoms.
  3. Try to maintain a balanced diet and regular exercise routine. These can help manage symptoms of IBS and CFS.
  4. Stay hydrated, especially if you're experiencing diarrhea.

What you should look out for

Seek immediate medical attention if you experience:

  • Severe abdominal pain
  • Blood in your stool
  • Unexplained weight loss
  • Difficulty swallowing
  • Persistent vomiting
  • A high fever (over 100.4°F)

Remember, this advice is intended to be general in nature, and specific causes may not apply to your situation. Always consult with a healthcare provider for accurate information.

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11 mo ago

People Also Ask


What are the common symptoms of Irritable Bowel Syndrome (IBS)?

Common symptoms of IBS include abdominal pain, bloating, gas, diarrhea, and constipation. The symptoms can vary in intensity and may be triggered by certain foods, stress, or hormonal changes.


How is Chronic Fatigue Syndrome (CFS) diagnosed?

Chronic Fatigue Syndrome is diagnosed based on a thorough medical history, physical examination, and ruling out other conditions. There is no specific test for CFS, so diagnosis often involves identifying a pattern of persistent fatigue that worsens with activity and does not improve with rest.


What are the potential causes of hypothyroidism?

Hypothyroidism can be caused by autoimmune diseases like Hashimoto's thyroiditis, certain medications, radiation therapy, thyroid surgery, or iodine deficiency. It can also be congenital or develop after pregnancy.


What lifestyle changes can help manage migraines?

Lifestyle changes that can help manage migraines include maintaining a regular sleep schedule, staying hydrated, avoiding known triggers (such as certain foods or stress), practicing relaxation techniques, and engaging in regular physical activity.


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