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
Dr. DiPiero Video Guide to this Case Study
Resource Center
Testimonials
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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 could cause intermittent lower abdominal pain and diarrhea in a 26-year-old woman?
What is Irritable Bowel Syndrome (IBS)?
What symptoms are associated with IBS?
How do you diagnose Celiac Disease?
What is Small Intestinal Bacterial Overgrowth (SIBO)?
What are the dietary triggers for Celiac Disease?
When should I seek medical attention 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
Hi there! How may I help you today?
Patient
I have lower belly pain and diarrhea.
Cody, the AI Doctor
So you want to focus on your lower abdominal pain and diarrhea today, is that correct?
Patient
Yes, that's right.
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 these symptoms. Have you noticed any specific triggers or patterns associated with your abdominal pain and diarrhea?
Patient
It's hard to say. The pain and diarrhea seem to come and go without any clear pattern.
Cody, the AI Doctor
I see. Have you been diagnosed by a health professional with any medical conditions in the past?
Patient
No, I haven't.
Cody, the AI Doctor
It's helpful to know that you haven't been diagnosed with any underlying medical conditions. In what year were you born and what is your sex?
Patient
1997, and I am a female.
Cody, the AI Doctor
Understanding your age and sex helps me provide more personalized care. Are you currently taking any medications, including over-the-counter drugs or supplements?
Patient
No, I'm not taking any medications.
Cody, the AI Doctor
How would you describe the start of your symptoms? Did they begin suddenly or gradually?
Patient
They started gradually about a year ago.
Cody, the AI Doctor
On a scale of 1 to 10, with 1 being no problem and 10 being very severe, how would you rate the severity of your abdominal pain?
Patient
I'd say it's around a 4 on most days, but sometimes it can go up to a 6 or 7.
Cody, the AI Doctor
How often do you experience diarrhea, and what is the consistency of your stools?
Patient
It's pretty intermittent. Some weeks I'll have normal stools, but then I'll have several days of loose to watery stools.
Cody, the AI Doctor
Have you noticed any blood or mucus in your stools?
Patient
No, I haven't seen any blood or mucus.
Cody, the AI Doctor
Do you have any associated symptoms, like nausea, vomiting, or fever?
Patient
No nausea or vomiting, but I do get bloated and feel fatigued sometimes. Also, I've lost about 5 pounds over the year.
Cody, the AI Doctor
I see. Has the weight loss been intentional, or was it unexpected?
Patient
It was unexpected. I haven't changed my diet or exercise routine.
Cody, the AI Doctor
Have you noticed any improvement or worsening of your symptoms with specific foods or dietary changes, for example, after consuming dairy, gluten, or other specific items?
Patient
I haven't noticed any clear connection to specific foods, but I do sometimes feel worse after eating.
Cody, the AI Doctor
Is there any chance you could be pregnant?
Patient
No, I'm on birth control and my periods have been regular.
Cody, the AI Doctor
Have you experienced any changes in your urinary habits or pain during urination?
Patient
No, I haven't noticed any changes in my urinary habits.
Cody, the AI Doctor
Do you experience any menstrual irregularities, severe pain during periods, or have any history of reproductive health issues?
Patient
No, my periods are pretty regular, and I don't have significant issues with them.
Cody, the AI Doctor
Do you drink alcohol or use any illicit drugs?
Patient
I have a glass of wine occasionally, but I don't use any drugs.
Cody, the AI Doctor
Have you traveled anywhere recently, or had any changes in your living conditions that coincide with the start of your symptoms?
Patient
No, no significant travel or lifestyle changes.
Cody, the AI Doctor
Have you been on any antibiotics in the past year?
Patient
Maybe 3 days for a urinary tract infection.
Cody, the AI Doctor
Have you had any operations in the past, especially operations on your gut, intestines, stomach?
Patient
No, never.
Cody's AI Summary
- A 26-year-old woman with intermittent lower abdominal pain and diarrhea over the past year.Â
- The symptoms started gradually and include associated abdominal bloating, intermittent fatigue, and an unexpected 5-pound weight loss.Â
- You have no history of chronic illness and have experienced regular menstrual cycles with no urinary or gynecologic related concerns.Â
- There is no noticeable pattern relating to specific foods.
- You have no family history of gastrointestinal conditions, and no personal history of gastrointestinal operations and no history of significant or repeated antibiotic use.Â
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) (55 % probability)
A functional gastrointestinal disorder characterized by abdominal pain and altered bowel habits, often associated with bloating and fatigue without an identifiable organic cause.
2. Celiac Disease (30 % probability)
An autoimmune disorder where ingestion of gluten leads to damage of the small intestine, potentially causing diarrhea, weight loss, and fatigue.
3. Small Intestine Bacterial Overgrowth (SIBO) (20% probability)
A condition where excessive bacteria are present in the small intestine, leading to symptoms like bloating, diarrhea, and sometimes weight loss.
Review by Dr Albert DiPiero
Dr. Albert DiPiero
The patient is a 26-year-old woman presenting with intermittent lower abdominal pain and diarrhea for a year. These are very common but aggravating symptoms. The history doesn't reveal any chronic illnesses, dietary triggers, or recent lifestyle changes. Considering her symptoms and medical history, let's dive deeper into the differential diagnosis:
1. Irritable bowel syndrome (IBS) (75 % probability)
IBS is a functional gastrointestinal disorder characterized by abdominal pain and altered bowel habits without an identifiable organic cause. Your symptoms of intermittent abdominal pain, diarrhea, and bloating align well with IBS, and the gradual onset over a long period supports this diagnosis. The lack of blood in your stool and absence of significant weight loss to suggest a more serious organic disease also fits this pattern.
2. Celiac Disease (15 % probability)
Celiac disease is an autoimmune disorder triggered by the ingestion of gluten, which causes damage to the small intestine. Although you haven't noticed a specific pattern related to gluten, your symptoms of intermittent diarrhea, fatigue, and weight loss could be consistent with celiac disease. The fact that you don't have a family history or an identified trigger pattern lowers its rank somewhat, in my opinion.
3. Small Intestine Bacterial Overgrowth (SIBO) (10% probability)
SIBO, often an overlooked condition, occurs due to the abnormal growth of bacteria in the small intestine, leading to symptoms such as bloating, diarrhea, and sometimes weight loss. While your symptoms match this condition, the intermittent nature of your symptoms, the lack of malodorous stool, and the lack of a direct correlation to antibiotic use or history of surgery reduces its likelihood compared to IBS and celiac disease.
4. Other Considerations
I would also keep in mind the following possibilities, but currently these seem less likely: Infectious gastroenteritis, lactose intolerance, food intolerance or allergies, inflammatory bowel disease, thyroid disorders, and microscopic colitis.
Next Steps for Evaluation
Examination: a thorough abdominal examination is highly recommended to determine the severity of condition.
Laboratory Tests: Complete blood count, CRP, and stool studies to check for infection or inflammation, a TSH to check for thyroid conditions, and a comprehensive metabolic panel would all be part of an initial evaluation. I would also perform serological tests (tTG-IgA) for Celiac disease, followed by an endoscopic biopsy if positive. If SIBO remains a strong consideration, a hydrogen breath test can help confirm the diagnosis.
Other: A CT scan of the abdomen and pelvis and a colonoscopy would be used to check for structural abnormalities, but I do not believe these are necessary at this point.
Potential Treatment Modalities
Comprehensive Treatment: Assuming IBS, symptom management with dietary changes (a low-FODMAP diet), antispasmodics, and possibly low-dose antidepressants, have all been found helpful. I would also recommend a dairy-free diet trial in case there is secondary lactase deficiency due to another gastrointestinal disorder such as IBS or celiac disease, resulting in transient lactase deficiency and presenting with symptoms similar to lactose intolerance. Personalized treatment plans focusing on diet and symptom management will be essential for all these conditions.
Dr. DiPiero Video Guide to this Case Study
Resource Center
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