Question 267

Question:

A 30-year-old woman has anxiety about episodes of abdominal pain that have alternated with diarrhea and constipation over the past year. She often has these episodes when she is stressed or tired. Physical examination and laboratory studies are within normal limits during these episodes. Which of the following is the most likely diagnosis?

Correct Answer: D.  Irritable bowel syndrome

(D) The most likely answer is irritable bowel syndrome. Alternating periods of constipation/diarrhea associated with psychosocial stress is typical of IBS. Physical and laboratory studies are normal in IBS.

(A) Gastroenteritis generally follows more of an acute timeline, does not wax and wane, constipation is not typically a component of the illness, and gastroenteritis implies that there may be nausea/vomiting from stomach involvement.

(B) Generalized anxiety disorder involves chronic anxiety often with little to provoke the anxiety and may include physical symptoms, but alternating periods of diarrhea/constipation is not a common complaint. Additionally, patients with GAD will tend to complain of anxiety related to a variety of everyday problems. This woman’s anxiety is related specifically to her GI complaint.

(C) We are not given any information to lead us to a diagnosis of hypochondriasis. She has no history of multiple visits to the doctor or hospital with undiagnosed problems.

(E) We are not given information that would lead us to a diagnosis of major depressive disorder. This woman’s anxiety is related to her GI complaints.