12-15-2008, 02:21 PM
A 27-year-old woman is evaluated for abdominal pain and discomfort occurring intermittently over the past 2 years. She describes the pain as crampy, occurring diffusely in the lower quadrant. She experiences some relief with defecation. The abdominal pain is usually associated with 3 to 5 days of loose, watery stools. Between episodes, she feels fine and has normal, formed stools. She has not had fecal urgency, hematochezia, weight loss, fever, arthralgia, or rashes. Her medical history includes depression occurring after the death of her father when she was aged 22 years, for which she received 6 months of antidepressant therapy with good response. She is not currently depressed. Her family history is negative for colon cancer and inflammatory bowel disease.
On physical examination, she is well developed and appears well nourished. Vital signs, including temperature and blood pressure, are normal. The remainder of her examination is unremarkable. Laboratory studies obtained within the past 6 months, including complete blood count, renal function and liver chemistry tests, and serum thyroid-stimulating hormone, electrolyte, and calcium levels, were normal.
Which of the following treatment options is most appropriate for this patient?
A Nortriptyline
B Sertraline
C Loperamide
D Alosetron
E Psyllium
On physical examination, she is well developed and appears well nourished. Vital signs, including temperature and blood pressure, are normal. The remainder of her examination is unremarkable. Laboratory studies obtained within the past 6 months, including complete blood count, renal function and liver chemistry tests, and serum thyroid-stimulating hormone, electrolyte, and calcium levels, were normal.
Which of the following treatment options is most appropriate for this patient?
A Nortriptyline
B Sertraline
C Loperamide
D Alosetron
E Psyllium