instruction: hello doctor my mother is 65 years old diabetic she has hypertension hypothyearoid and thalassemia minor she is anemic too for 10 days she has been having alternately bloated stomach diarrhea constipation and lower back pain what could these be symptoms of
output: hello I can understand you must be very upset about your mother for her troubling symptoms you know diabetes hypertension are chronic ailments that can affect every system of the body some of these effects particularly of diabetes are related to the gastrointestinal tract git certain conditions like diabetic gastropathy involving the stomach diabetic enteropathy when involving small bowel can cause bloating alternate diarrhea with constipation such as in her case it is highly likely that she has one of two of above mentioned conditions but to be on the safe side I will suggest you some tests as we can rule out anything other than this meanwhile start her on tablet digestive metoclopramide 40 my once daily half an hour before meals start her on tablet rifaximin 200 my thrice daily for three weeks this is a safe antibiotic which will correct her abnormal bacteria within the small and large bowel this will help her control her production in the long term use fibrocol or any other fiber which is available two tablespoons full with water once daily with water and the most important of all tight control of her sugars since the problem is secondary to diabetes once diabetes is controlled fairly enough her symptoms improve itself I hope this helps diabetic gastroparesis diabetic enteropathy small intestinal bacterial overgrowth functional bloating and gas complete blood count abc hba1c glycated hemoglobin ash thyearoid stimulating hormone ft4 ft3 vitamin b12 and rec folate serum albumin bun creatinie electrolytes calcium phosphorous magnesium serum cop stool for ova and parasites stool for fat globules and reducing substance stool for difficile stool for fecal calprotectin stool for pyloric antigen follow up after week of use of above medication to see how she respond meanwhile get above mentioned investigation please do not get frightened seeing list of investigations they are just a through overall assessment of her condition if she already had some of these tests before then please do not get those