History of chronic low back pain-bipolar disorder

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History of present Illness: A 58-year-old female with a complicated history of chronic low back pain, bipolar disorder, mixed anxiety, and depressive disorder present to the office with a complaint of constipation for several months. The constipation is intermittent and has worsened over the past few weeks. She is now having a bowel movement about every 4 days; reports stools are hard and painful, and she has bright red blood on the toilet paper when she wipes herself. She does not feel she is able to completely evacuate her bowels. She denies melena, abdominal pain, bloating or excessive gas, loose stools, or fecal incontinence. She is afraid to take medications and has not tried any OTC treatments for fear of the side effects. She has no changes in her regular medications and no short-acting narcotics for breakthWhat are your differentials? What is the most likely diagnosis? Why? What supports this diagnosis? Discuss the pathophysiology regarding the chosen diagnosis? Should any tests/imaging be ordered? Which ones and why? What are the next appropriate steps in management? What are the treatment options for this diagnosis? Would your prescribe any medications at today's visit? Use the Prescription Pad template Links to an external site. write the prescribed medication. What patient education would you give? Would you refer this patient to any other provider? If so, who and why? What medical/legal concerns might you have regarding the management of this patient?

Reference no: EM133878447

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History of chronic low back pain-bipolar disorder : A 58-year-old female with a complicated history of chronic low back pain, bipolar disorder, mixed anxiety, and depressive disorder present

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