reply to candace db

Abdominal bloating can be the result of many different ailments. Several questions can help the provider find the cause of the symptoms. The first question you can ask is when did she notice the bloating? This will help give some direction of how long the complaint has been going on and what may have caused it. If there is any associated pain and if so when was the onset, duration, frequency and relationship can help eliminate causes and questions such as: Does it get better or worse when you eat certain foods? Does movement or rest alleviate symptoms? Where is the bloating feeling exactly? Location can provide clue regarding the mechanism of the bloating. Has she has had any nausea or vomiting? Although the patient has passed gas, this writer would ask when was the last bowel movement because the patient could also be constipated. 
The physical examinations should include vitals and assessment of the abdomen (inspection, auscultation, percussion, and palpation). Included in the physical exam of this visit will be an oral exam making sure to thoroughly exam the teeth and the mucosa for sores, noting the teeth and mucosal colors. A musculoskeletal exam would also be performed noting any muscle weakness, fatigue, joint pain, numbness or tingling. Generalized skin exam noting skin color, lesions, or rashes. Neurological examination for headaches, migraines, or confusion. Psychosocial for any anxiety or depression. Social habits for any drug or alcohol abuse. There are tons of differential diagnoses that comes along with abdominal pain since this area can reciprocate pain from other areas in the body. Differential diagnosis can include constipation, bowel obstruction, Chrons, food allergies, enteritis, irritable bowel syndrome or celiac disease.
Test should be ordered and performed along the history and physical to help assist diagnosing. A complete blood count, serum chemistries, liver function tests, urinalysis, pregnancy test, and abdominal films will help determine the acuity of the problem (Dunphy, Winland-Brown, Porter, & Thomas, 2015). Antibody levels that are elevated indicate an immune reaction to gluten. Genetic testing could also be an option, and might include antigens that are used to rule out celiac (Bascunan, Vespa & Araya, 2017). A kidney, utter, and bladder (KUB) x-ray may also be ordered to asses organs, structures, causes of the bloating. Further testing may include endoscopes and possible biopsy to rule out other gastrointestinal (GI) conditions. 
The main thing about managing any disease is diet, education, and pharmacological and nonpharmacological interventions. This is most true for IBS. If gluten is the issue, the patient must have a strict diet that includes avoiding wheat, barley, rye, malt, and more. Education is key. In doing so, this promotes decreased inflammation and intestinal healing (Mayo Clinic, 2018). Crohn’s disease can also be treated with latter. It is mostly treated with immunosuppressant drugs. Medical follow-up is also necessary to ensure a healthy body response to the new changes. If unresponsive to this surgical interventions are required. 
References
Bascuñán, K., Vespa, M. & Araya, M. (2017). Celiac disease: Understanding the gluten-free diet. European 
Journal of Nutrition, 56(2), 449–459. doi: https://doi-org.wgu.idm.oclc.org/10.1007/s00394-016-1238-5.
Dunphy, L., Brown, J., Porter, B., Thomas, D. (2015). Primary Care: The Art and Science of Advanced 
Practice Nursing. Philadelphia: F.A. Davis Company.
Mayo Clinic (2018). Celiac Disease. Retrieved from https://www.mayoclinic.org/diseases-conditions/celiac- (Links to an external site.)Links to an external site.
disease/diagnosis-treatment/drc-20352225 (Links to an external site.)Links to an external site..