Differential Diagnosis
The patient presents with a history of multiple polyp removals, current symptoms of blood in stool, and constipation. Here's a differential diagnosis based on the provided information:
- Single most likely diagnosis:
- Chronic Constipation: The patient reports going to the bathroom every four to five days, which is less frequent than normal, indicating constipation. The prescription of Reguloid and Miralax further supports this diagnosis, as both are used to treat constipation.
- Other Likely diagnoses:
- Colorectal Polyps or Cancer: Given the patient's history of 16 polyps removed in 2009 and current symptoms of blood in stool, it's possible that new polyps have developed or that there's a malignancy. The request for a colonoscopy is appropriate to investigate this possibility.
- Hemorrhoids: Blood in stool can be a symptom of hemorrhoids, especially if the patient is constipated, which can cause straining during bowel movements and lead to hemorrhoid development.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Colorectal Cancer: Although the patient has a history of polyp removal, the presence of blood in stool necessitates ruling out colorectal cancer, as it can be life-threatening if not diagnosed and treated promptly.
- Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease or ulcerative colitis can cause blood in stool and constipation. While less likely, these conditions can have significant morbidity if not properly managed.
- Rare diagnoses:
- Intussusception: A condition where a part of the intestine slides into an adjacent part, which can cause bowel obstruction and bleeding. It's rare in adults but can occur, especially with a history of polyps.
- Angiodysplasia: Vascular malformations in the GI tract that can cause bleeding. This condition is more common in the elderly and can be a cause of occult or overt GI bleeding.