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1Week 8- Case study 3A 7-year-old patient comes into the clinic with abdominal pain. Further subjective data reveals frequent stool soiling and a history of constipation since infancy. The patient does not remember when her last bowel movement was, but her mother states that she had an accident at afamily gathering last night, where she stooled in her underwear before reaching the bathroom. On exam, the provider notes palpable stool in the descending colon and an enlarged rectal vault with hard stool. Primary DiagnosisThe primary diagnosis is fecal impaction. Constipation can lead to fecal impaction as an acute complication (Araghizadeh, 2005). Clinical manifestations include abdominal pain, abdominal distention, fecal incontinence, nausea, and vomiting (Araghizadeh, 2005). Symptoms occur from the hardened stool that becomes impacted in the rectum or distal sigmoid colon (Araghizadeh, 2005). Most impactions occur in the rectal vault (Araghizadeh, 2005). Fecal impaction can inhibit a person’s ability to sense and respond to stool in the rectum, causing incontinence (Rao, 2020). Differential DiagnosisEncopresisEncopresis is defined as frequent fecal soiling related to prolonged constipation (Blackmer & Farrington, 2010). This typically occurs after the age of four (Blackmer & Farrington, 2010). Encopresis is associated with children who hold their stools (Blackmer & Farrington, 2010). Soiling transpires when hardened stool is retained in the rectum, causing an overflow of loose stool around the harden stool (Blackmer & Farrington, 2010). The retention of stool overtime leads to distention of the colon,
2stretching of the rectum, ineffective peristalsis, and weakened sphincter muscles (Burns et al., 2017). Clinical manifestations include abdominal pain, painful bowel