1. A 28-year-old woman reports several years of cramp-like lower abdominalpain associated with abdominal bloating , rectal urgency , and frequent loose,non-bloody, small-volume stools and mucus . The pain i s worse after mealsand is partially relieved with defecation or passage of flatus . At other times,the patient reports having to strain to pass hard stools. There is no fever,weight loss , rashes , joint or eye pain . She considers herself 11 anxious 11 and thinks her symptoms get worse with stress and menses.Physical exam reveals an anxious woman who makes poor eye contact,abdomen with a small right lower quadrant surgical scar, and mild tenderness that is most evident in the left lower quadrant.1. Discuss the possible diagnosis?2. What are the alarm symptoms that necessitate colonoscopy insuch cases?3. What is the management of this patient? 2. A 34 year old gravid woman with a history of ileal Crohn ‘ s disease presentedat 30 weeks’ gestation with a 2-week history of fever up to 3 8 . 6°C, rightupper quadrant pain and nausea. The right upper quadrant pain was constantand radiated to her back . S he did not experience any changes in her bowelhabits and had no episodes of vomiting.On physical examination , she had a gravid abdomen with normal bowelsounds and significant tenderness on palpation of the right upper quadrant .Initial investigations included a minalysis and urine culture, which wereunremarkable, and elevated white-blood-cell count of 1 2 x 1 09/1 with 75%neutrophils and 1 2% bands . Her metabolic profile and liver function testswere unremarkable.1. Discuss the differential diagnosis2. How to reach your diagnosis?
