Reference no: EM133786502

Question 

Provoking Factors for Diarrhea: Ruled Out Factors: Sick Contacts: J.G. denies direct contact with anyone experiencing similar symptoms. Recent Travel: J.G. denies recent domestic or international travel. Factors to Consider: Medication Side Effects: Metformin, which J.G. started 2 weeks ago, is known to cause gastrointestinal disturbances, including diarrhea. Irritable Bowel Syndrome (IBS): J.G. has a history of IBS, which can be exacerbated by stress or dietary changes, even if not immediately apparent. Missing Medications: Imodium (Loperamide): Used for diarrhea relief. Important to document dosage, frequency, and last dose taken. Pepto-Bismol (Bismuth Subsalicylate): Also used for diarrhea relief. Document dosage, frequency, and last dose taken. Problem List: Acute Diarrhea: 5-10 soft, unformed stools per day for 7 days. Increased Hemorrhoidal Bleeding: Associated with defecation. Sinus Tachycardia: Heart rate of 114 bpm. Hypertension: BP 118/99, controlled on medication. Type 2 Diabetes Mellitus: Recently diagnosed, stable on metformin. Missing System in Physical Exam: Rectal Examination: This is relevant to assess for hemorrhoids, anal fissures, or other anorectal issues contributing to bleeding and discomfort. Cause of Acute Diarrhea: Metformin-Induced Diarrhea: Metformin is a common cause of gastrointestinal side effects, including diarrhea, especially when newly initiated. This aligns with the timing of J.G.'s symptoms starting.