Emma in case

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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