From the Guidelines
When evaluating a patient with constipation, lower abdominal pain, pressure with sitting, fever, and chills, I would focus on obtaining a comprehensive history that includes duration and progression of symptoms, bowel habits, and risk factors for serious conditions. This approach is supported by the most recent and highest quality study, which emphasizes the importance of a detailed medical history in diagnosing and managing gastrointestinal disorders 1.
Key Components of Medical History
The following components should be included in the medical history:
- Duration and progression of symptoms
- Bowel habits, including stool characteristics (frequency, consistency, presence of blood or mucus) and any recent changes
- Pain characteristics, including location, radiation, aggravating/alleviating factors, and relationship to bowel movements
- Fever pattern, chills, and associated symptoms like nausea, vomiting, urinary symptoms, or weight loss
- Medication history, particularly opioids, anticholinergics, calcium channel blockers, and recent antibiotics
- Recent procedures, surgeries, or trauma to the abdomen/pelvis
- Medical history for inflammatory bowel disease, diverticulitis, colorectal cancer, or perianal conditions
Importance of Medication History
Medication history is crucial in evaluating patients with constipation, as certain medications can contribute to constipation or worsen symptoms 1.
Risk Factors for Serious Conditions
The combination of fever, chills, and localized symptoms suggests an infectious or inflammatory process that requires prompt evaluation to prevent complications like sepsis or abscess formation 1.
Conclusion is not allowed, so the response is ended here.
From the Research
Relevant Medical History
The patient's relevant medical history for constipation, lower abdominal pain, and pressure when sitting, fever, and chills includes:
- A history of constipation, which can be a common condition experienced by all age groups 2
- Abdominal pain, which can be a symptom of various conditions, including musculoskeletal or nonmusculoskeletal origins 3
- Fever and chills, which can indicate an infection or inflammatory process 4
- Pressure when sitting, which can be related to abdominal wall abscesses or other abdominal complications 5
Potential Underlying Conditions
Potential underlying conditions that may be contributing to the patient's symptoms include:
- Diverticulitis, which can cause abdominal pain, fever, and chills 5
- Abdominal wall abscesses, which can cause pressure and pain in the abdominal area 5
- Intra-abdominal hypertension, which can impair the outcome of critically ill patients 6
- Musculoskeletal conditions, such as greater trochanteric or iliopsoas bursitis, which can cause abdominal pain 3
Important Assessment Factors
Important factors to consider when assessing the patient's condition include:
- Clinical history, including any recent changes in bowel habits or medication use 4, 2
- Lifestyle factors, such as diet and physical activity, which can contribute to constipation 2
- Physical examination findings, including abdominal tenderness or rigidity 4
- Laboratory results, such as complete blood counts or imaging studies, which can help diagnose underlying conditions 5, 4