Emma in case
Skin, Hair, Eyes, Nails
Pale clammy skin
Many bumps. Some infected
Glossitis and lichen on tongue
Nails
White spots
Horizontal ridges
Eyes
Grey jagged ANW
Stream and white fibres
Pulsating pupil
Endocrine System
On OCP from 17-24
Headaches during period
History of Abortion. Miscarriage 1 year ago
hepatobiliary
Bloating
Pain
GIT
Undigested food in poo
Microbiome imbalance from IBS
Antibiotics once a year
Consitipation is normal
Stools float and fatty sheen evident in toilet water
Opens bowels every few days
Fatigue
Watery diarrhoea
Foul smelling, explosive, light brown tan
Has bloating and distention relieved by flatulence
Worse for eating certain foods
Weakness in junctions between enterocytes
Better for bland diet
Occurs every 2 weeks
Abdominal Pain 6/10 every 2 weeks
Differential Diagnosis
Send to GP for glucose tolerance test
Chrone's disease due to systemic inflammation and no blood in diarrhoeh
Percinious Anaemia
Given high MCH, low MCV, low Haematocrit and low Haemoglobin
MSK
Joint pain 4/10
knees, shoulders, elbows and ankles following bout of watery diarrhoeah which occurs every forntight
Immune
Colds linger for a few weeks
Recurrent vaginal thrush when on OCP
CVD
high MCH, low MCV, low Haematocrit and low Haemoglobin
Low iron
Low Blood Pressure
Peripheral return slow
Nervous System
Light headed and dizzy and difficulty concentrating after diarrhoea
Sleeping 6 hours. Wakes unrefreshed
Linked to SNS dominance
SNS increases insulin
Subtopic
Generally good mood
Family History
Diabetes
Lifestyle
Eats while working
Smoking
Stressful and demanding job
High achiever
Diet
High salt diet
1 Coffee, 1 Tea
One wine three nights a week
No water
