Case 2 AN OFFICE VISIT WITH AN ELDERLY WOMAN



Case 2 Complaints of Constipation During an Office Visit

Authors:

Claudene George, MD, Assistant Professor of Medicine, Geriatrics Fellowship Program Director, Student Clerkship Director, Albert Einstein College of Medicine, Montefiore Medical Center

Laurie G. Jacobs, MD, Professor of Clinical Medicine and Vice Chair of Clinical and Educational Programs, Department of Medicine, Director, Jack and Pearl Resnick Gerontology Center, Albert Einstein College of Medicine, Montefiore Medical Center.

Setting: Outpatient office visit, patient accompanied by her daughter-in-law

Chief complaint: An 85 year old white woman comes to the office with a complaint of “constipation for several months.”

History of Present Illness:

The patient has complained of hard stools every third day, dark brown, for several months. She hasn’t noticed any change in caliber, but claims she is straining to defecate and sometimes has streaks of blood around the stool. She hasn’t changed her diet and has not been ill recently.

Question 1:

Which description can be formally considered “constipation“?

bowel movements every other day

bowel movements every third day

patient discomfort with defecation

bowel movements once a week

incomplete evacuation

all of the above

Answer: f

Medically, constipation is often defined as a frequency of ................
................

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