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INSTRUCTIONS FOR THE DOCTOR

This is a short case.

Please take a history from Jenna and then ask the facilitator for the results of a focused examination. Tell Jenna the most likely diagnosis and your initial management plan.

Scenario

Jenna Banks is a 25-year-old tax manager studying for her chartered accountancy exams. You last saw her for contraception. She is coming to see you today because of recurrent abdominal pain and bloating.

The following information is on her summary sheet:

  • Past medical history

  • Fracture left humerus aged eight, from a rollerblading accident

  • Medication

  • On contraceptive pill

  • Levonorgestrel 150 mcg, ethinyloestradiol 30 mcg (Levlen ED)

  • Allergies

  • Nil known

  • Immunisations

  • Up-to-date

  • Cervical screen

  • Normal a few months ago

  • Family history

  • Parents both alive and well

  • Social history

  • Non-smoker

  • Alcohol—two standard drinks on two occasions per week.

INSTRUCTIONS FOR THE PATIENT, JENNA BANKS

You are a 25-year-old tax manager studying for your chartered accountancy exams. Your abdominal pains started after you contracted traveller’s diarrhoea during a trip to Bali six months ago. You saw a GP when your pain symptoms weren’t improving and stool tests were negative for infection. Things have been worsening over the last few months as your stress regarding your accountancy exams has increased. Most days of the week you experience bouts of abdominal pain, bloating and flatus. The pain can be so severe that you need to lie down but mostly you can continue at work. The pain comes on at any time during the day, and is a squeezing, cramp-like pain, usually in the left or right side of your abdomen. The pain is sometimes relieved by defecating. You have never woken at night with symptoms.

You have not lost weight, been nauseated or vomited. Your bowel habit alternates between constipation (hard, rabbit-like pellets) and diarrhoea. You do not pass any blood or mucus rectally. You have not noticed any particular food triggers. You have tried some herbal remedies which did not improve your symptoms.

You are stressed and anxious regarding your exams, but are not depressed. You have no past history of anxiety or depression.

Your periods are regular on the contraceptive pill, and your bowel symptoms do not worsen with your menstrual cycle.

You want the doctor to make sure that you have nothing seriously wrong with you and to tell you what the problem is.

The following information is on your summary sheet:

  • Past medical history

  • Fracture left humerus aged eight, from a rollerblading accident

  • Medication

  • Levonorgestrel 150 mcg, ethinyloestradiol 30 mcg (Levlen ED)

  • Allergies

  • Nil known

  • Immunisations

  • Up-to-date

  • Cervical screen

  • Normal a few months ago

  • Family history

  • Parents both alive and well

  • Social history

  • Non-smoker

  • Alcohol—two standard drinks on two occasions per week.

INSTRUCTIONS FOR THE FACILITATOR

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