Workup Plan for Difficult Case

Integrative Diagnosis Work-Up Plan

Building on the information gained in the consultation as well as peer-feedback of Difficult Case Presentation, students will present a work-up plan for further diagnostic testing and imaging. Workup plan includes three parts as below:
1: Differential Diagnosis: Work-up plans should include at least one “decision-tree”/flow chart, in which the results change the next step. The work-up plan should include what happens next based on either result. For example, an imaging study is normal and the patient is still in pain (now what? More tests?) vs. the imaging study is definitive (how does the treatment/team change?). This is no more than 1 page
2: Summery and Plan: Work-up plan should also include a summary of your difficult case, including information you used for your case presentation, and the latest diagnostic and treatment plan (selecting your most likely diagnosis for the case) in Conventional medicine and in Chinese medicine for this case. At least three citations for Western medicine treatments and two citations for TCM treatments are required. This is about two to three pages.
3: Patient Treatment Plan: Prepare a written plan to share with the patient. This is no more than 1 page
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I would like to write a workup plan about this case below
I have a patient that’s been coming in for the past 2 months but is not responding to the treatment and would like refer to you for your evaluation and co-treatment.

30 year old female that is a red flag Diverticulitis She is experiencing abdominal pain on her lower left side of the abdomen This has been going on for the past 5 months. Passed history she did have a gallbladder removal 3 years ago that was overly packed with stones.
The patients pain keeps getting worse after every meal also with pressure. She usually sleeps on her side but due to the chronic pain she sleeps on her back so she would not apply any pressure on her abdomen. The pain is constant and stabbing. Throughout the day she is fatigue with a low appetite. She is also experiencing constipation that makes the pain worse.
She goes to the gym 3 times a week and as soon as she gets on the treadmill her pain starts to accumulate. There is no family history. She takes Ibroprofen as soon as she gets pain. I preformed a Rebound Tenderness exam on her and it came out positive. I also preformed deep needling and electrical stimulation. Also prescribed her an herbal formula Bao He Wan For the painful distention that occurs after meals. The treatment went on for 8 weeks. Patient had a CBC done by PCP that came back “normal” and the hemoccult came back negative. Her Primary care physician diagnosed her with Diverticulitis.

TCM ( TRADITIONAL CHINESE MEDICINE) DIAGNOSIS

After reviewing her signs and symptoms then diagnosing the tongue which is swollen purple with dark sublingual and a choppy pulse. I diagnosed her blood stasis in the Stomach.
After 12 weeks within the treatment there wasn’t any improvements which is uncommon in traditional Chinese medicine. She will need aggressive diagnostic as there can be an additional case. I would really appreciate your help and your insight on this case. And would like to request a CT Scan for imaging. Another CBC and white blood count also a monospot test to rule out a mononucleosis

What else can cause constipation? PLEASE ADD THIS TO THE WORKUP PLAN

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