Table of Contents
Common Questions
Chat with CodyMD
Cody's Chat with Patient
Cody's AI Summary
Top 3 AI Diagnosis List
Review by Dr Albert DiPiero
Resource Center
Testimonials
Share this Case Study
Case Study
Meet your host
Albert DiPiero, MD MPH FACP
I am a co-founder and the Chief Medical Officer at CodyMD and your host for this edition of Cody Grand Rounds. I have been a practicing physician and faculty member at medical schools for over 26 years.
About The AI Doctor Case Study
CodyMD is a partnership between Human Doctors and AI Doctors. Cody is an AI Doctor who helps thousands of people every day. At each Cody Grand Rounds, I select a real case and review it with Cody, the AI Doctor.
Each case is based on a real patient but has been modified to maintain privacy and to emphasize certain teaching points.
Common Questions
What is irritable bowel syndrome (IBS)?
What are the common symptoms of IBS?
How is IBS diagnosed?
What are the treatment options for IBS?
Is lower abdominal pain after a bowel movement a sign of IBS?
Can diet affect lower abdominal pain after a bowel movement?
What is diverticulitis?
When should I see a doctor for abdominal pain?
Chat with CodyMD
Click the button below to initiate a conversation with CodyMD, your AI Doctor.
Cody's Chat with Patient
Below is a conversation transcript between the patient and our AI Doctor CodyMd.
Cody, the AI Doctor
How may I help you today?
Patient
Lower abdominal pain after pooping.
Cody, the AI Doctor
So you want to focus on the lower abdominal pain after pooping, is that correct?
Patient
Yes.
Cody, the AI Doctor
Good to meet you! My goal is to provide you with an accurate assessment and plan. Let's talk about your concerns regarding lower abdominal pain after pooping. Please describe your lower abdominal pain after pooping. What type of pain are you experiencing? Is it cramping, sharp, dull, or constant?
Patient
Dull pain with mild discomfort.
Cody, the AI Doctor
Dull pain with mild discomfort after pooping can sometimes be associated with conditions like irritable bowel syndrome (IBS) or constipation. When did you first start experiencing lower abdominal pain after pooping?
Patient
Nine months back.
Cody, the AI Doctor
By the way, our conversations are always private. Lower abdominal pain after pooping for nine months could indicate a chronic issue that may require further evaluation by a healthcare provider. Have you been diagnosed by a health professional with any medical conditions that could be related to your symptoms? For example, inflammatory bowel disease or diverticulitis?
Patient
No.
Cody, the AI Doctor
Chronic lower abdominal pain after pooping for an extended period may be a sign of an underlying condition. In what year were you born?
Patient
1968.
Cody, the AI Doctor
The year of birth can help me understand your age and provide better care. What is your sex?
Patient
Male.
Cody, the AI Doctor
Understanding your sex can also help in providing more personalized care and treatment. How did your lower abdominal pain after pooping start? Did it start suddenly or gradually?
Patient
Suddenly.
Cody, the AI Doctor
Lower abdominal pain that starts suddenly after pooping can sometimes be related to conditions like irritable bowel syndrome or inflammatory bowel disease. Is your lower abdominal pain after pooping getting worse, getting better, staying the same, or does it vary day to day?
Patient
Staying the same. Sometimes bloating and farting.
Cody, the AI Doctor
Lower abdominal pain that starts suddenly after pooping can sometimes be related to conditions like irritable bowel syndrome or inflammatory bowel disease. On a scale of 1 to 10, how would you rate the severity of your lower abdominal pain after pooping, where 1 is no problem and 10 is very severe?
Patient
2.
Cody, the AI Doctor
Lower abdominal pain that starts suddenly after pooping can sometimes be related to conditions like irritable bowel syndrome or inflammatory bowel disease. Do you have diarrhea or constipation along with the lower abdominal pain after pooping?
Patient
Well-formed stool passes very suddenly. Toilet procedure ends in one to two minutes. No tenesmus. But crampy pain after the toilet.
Cody, the AI Doctor
Thank you for that information. Since your stool is well-formed and passes quickly, let's discuss the frequency. How often do you have bowel movements each day or week?
Patient
Once a day, usually in the morning.
Cody, the AI Doctor
That sounds fairly regular. Can you think of any foods or activities that seem to trigger your lower abdominal pain or bloating?
Patient
Spicy foods and sometimes dairy seem to make it worse.
Cody, the AI Doctor
Spicy foods and dairy can sometimes exacerbate symptoms in conditions like IBS. Have you noticed any changes in your appetite or experienced any unintentional weight loss over the past nine months?
Patient
No appetite changes, and my weight has been pretty stable.
Cody, the AI Doctor
That's useful to know. Have you experienced any nausea, vomiting, or fever along with your symptoms?
Patient
No, none of those symptoms.
Cody, the AI Doctor
It’s good that you don’t have those symptoms. Have you tried any over-the-counter medications or home remedies for your pain, and if so, have they been effective?
Patient
I tried antacids and peppermint tea, but they don’t seem to help much.
Cody, the AI Doctor
Understanding what hasn't worked can also be informative. Do you ever notice mucus or blood in your stool.
Patient
No, I've never seen any blood or mucus in my stool.
Patient
That helps rule out some conditions. Have you had any previous abdominal surgeries or significant injuries that might be related to your current symptoms?
Patient
No surgeries or major injuries.
Cody, the AI Doctor
Understood. Lastly, have you experienced any changes in your urinary habits, such as increased frequency, urgency, or pain during urination?
Patient
No changes in my urinary habits.
Cody's AI Summary
- You are a 55-year-old man with lower abdominal pain after bowel movements for the past nine months.
- The pain is described as dull with mild discomfort.
- The lower abdominal pain started suddenly and has been staying the same.
- You sometimes experience bloating and gas along with the pain.
- Your stool is well-formed and passes very suddenly, with no tenesmus.
- You rate the severity of your lower abdominal pain after pooping as 2 out of 10.
- You have no nausea, vomiting, fever, or weight loss
- You experience crampy pain after using the toilet.
Top 3 AI Diagnosis List
Based on the information and conversations with Cody, we have prepared a top 3 AI Diagnosis List.
1. Irritable Bowel Syndrome (IBS)( 60 % probability)
A common gastrointestinal disorder characterized by abdominal pain, bloating, and changes in bowel habits.
2. Gastroenteritis(<30 % probability)
Inflammation of the stomach and intestines, often caused by viral or bacterial infection.
3. Diverticulitis(10 % probability)
Inflammation or infection of small pouches that can form in the walls of the colon.
Review by Dr Albert DiPiero
Dr. Albert DiPiero
In reviewing the patient’s history and symptoms, I note the patient presented with a nine-month history of lower abdominal pain following defecation, described as dull and providing mild discomfort. The symptomatology initiated abruptly and has remained consistent, punctuated by occasional bloating and flatulence. The patient reports well-formed stools that are passed rapidly, suggesting an absence of tenesmus, though crampy pain is noted post-defecation.
1. DX(75% probability)
It is essential to consider IBS given the chronic nature of the patient's symptoms. The persistent nature of the abdominal pain, coupled with episodes of bloating and well-formed stools, fits well within the symptom spectrum of IBS. Additionally, the absence of significant alarm features such as weight loss, rectal bleeding, or nocturnal symptoms further strengthens the probability of IBS being the primary diagnosis.
2. Gastroenteritis(15% probability)
While gastroenteritis is predominantly an acute issue, a chronic presentation can occur in the context of a low-grade infection or ongoing dysbiosis or chronic infections with parasites. The patient’s consistent symptomatology over a prolonged period makes acute gastroenteritis less probable. However, it cannot be completely excluded due to factors such as potential chronic low-grade infections or post-infectious IBS.
3. Diverticulitis(10% probability)
The likelihood of diverticulitis is significantly lower due to the absence of severe pain, fever, or signs of acute inflammation. While diverticulitis might present with chronic, low-grade inflammation within diverticula, the described symptom pattern does not prominently align with it. Nonetheless, it remains a differential consideration, especially if there are any underlying diverticula that might contribute to the chronic discomfort.
4. Additional Consideration
Functional Gastrointestinal Disorders: These could account for bloating and pain without significant structural abnormalities. Chronic Constipation: could account for discomfort post-bowel movement.
Next Steps for Evaluation
Stool tests to exclude infections and assess gut flora.
Colonoscopy to rule out structural issues such as diverticulitis or neoplasia.
Functional assays like manometry if suspected motility disorder.
Potential Treatment Modalities
Dietary modifications like increased fiber intake for IBS symptom relief.
Probiotics or antibiotics for suspected dysbiosis.
Antispasmodics or laxatives based on stool consistency.
Resource Center
Stomach Pain Resources
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