Bloating

Patient is 30-year-old female who comes in due to history of bloating and abdominal cramping. This seemed to begun about eight years ago when she has had just occasional experiences. She states that it has been happening about one time per year. The first time her bloating and abdominal pain was so bad she went to the ER and they treated her for the pain. It does seem to last for about 12 hours and then it seems to resolve. They have done a CT scan of the appendix, abdomen and have found some inflammation in the appendix but nothing too severe. Her pain is associated in the epigastric region. It does not seem to travel anywhere else. This has beginning to happen more frequently so she thought to come here to see if it was any type of food allergy. She says that it has happened three times in the last year. First in September which brought her to the ER due to pain. She also was given morphine and developed hives that they gave Benadryl for. She also had an incident in January and March. It does seem to be associated with diarrhea during the 12-hour period but then that resolved. Then, she did have one vomiting event at last time. It does seem to be associated with tongue getting irritated. She says that the edges of her tongue become more serrated especially after eating certain berries and citrus fruits. It is not necessarily painful, does not cause open sores or swelling but is visibly noticeable.

She does not have a history of seasonable allergies. She has never had trouble with nasal itching or irritation or stuffiness or mouth breathing or snoring problems. She has had belching events that have seemed to be occurring with this as well and this does seem to occur in the middle of the night most frequently. She denies any history of sinus infection, nasal polyps, TMJ, frequent headaches, aspirin-induced nasal symptoms, nasal surgery, or frequent bad cold. She does state she gets annual tonsillitis infections and was recently about a week and a half ago developed upper respiratory infection and double pink eye but overall is usually healthy.

She denies any frequent ear infection. She does get dizziness and lightheadedness, and denies hearing impairment. She does state that she does not drink that much water and is going to try to do better.

She does admit some eye tearing but denies itching, redness, dryness, burning, light hurting her eyes, yellow discharge from eyes, eyelid swelling or eyelid irritation.

She denies any history of lung problems or asthma. She has had a chest x-ray and it was in the last five years. She does currently have some red patches on her lower legs that is not itchy or sore or raised just a little red broken blood vessels that started to occur but does not have any history of eczema or hives.

She has never been evaluated for allergies before.

ASSESSMENT:
1. Abdominal pain unspecified.
2. Bloating.
3. Concern for food allergy.
4. Possible small bowel overgrowth syndrome.

PLAN:
1. At this time, I talked with Alecia that she does not appear to have a specific food allergy however she does have significant abdominal complaints including severe cramping leading to the ER with diarrhea, bloating, and belching. I did encourage her to see gastroenterologist to follow up with this complete as it is becoming more frequent to see if they can provide her an endoscopy or other approaches to rule out anything abnormal.
2. We did discuss about imbalance in her microbiota and her gut that could be contributing to that. She has tried some probiotics. I also mentioned this to see that she could try and encouraged her to read the book The Gut Balance Revolution to help with her diet, behavior, and exercise techniques. This overall may help her maintain a healthy lifestyle.
3. We will follow up as needed if she has any other allergy concerns.

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