Patient History: A 22-year-old woman complains of tiredness for 6 months. Her only other symptom is a gradual increase in the frequency of bowel movements from once a day in her teens to two to three times daily. She has no abdominal pain and has no change in appetite. She says that the bowel movements can be difficult to flush away on occasions, but this is not a consistent problem. She is a non-smoker and drinks rarely. She has been a vegetarian for 5 years but eats dairy foods and fish regularly.
She thinks that her grandmother also had some bowel problems, but she died 3 years ago, at age 68. She is an infant-school teacher and spends a lot of her spare time in keep-fit classes and routines at a local gym. She enjoys her work and socializes regularly with a wide circle of friends. Physical Examination: She is 1.62 m (5 ft 4 in.) tall and weighs 49 kg. She looks a little pale and…
