Practice this case based on how you are assessed in your OSCEs, and use the relevant sections for general revision. 🤓
Doctor Instruction:
You are a Foundation Year Doctor at the Emergency Department. Your next patient is Jemma Morrison, a 36-year-old office worker presenting with a "tummy problem". Please take a history and perform a relevant examination.
Patient History:
You've had a horrendous episode of the runs! The diarrhoea started this morning when you suddenly woke up and had to rush to the toilet. You've been to the toilet 4 times already and have passed watery stool with no blood, greasy stool, or mucus and no offensive smell you’ve noticed.
You were at a wedding ceremony last night and had all sorts of dishes – it was an open buffet, so you ate everything you could.
You arrived one month ago from a holiday in Nairobi, Kenya, where you ate from the local restaurants and drank fresh water. But you were fine this whole past month since you arrived. You haven't had any recent hospital admissions or been on a course of antibiotics.
You’ve had some mild generalised tummy pain that’s dull and all over the place, about a 4/10. It’s not made better or worse by anything, and it’s coming and going in waves.
You feel sick but haven’t vomited. Your appetite is currently very poor, and you feel tired.
No dysphagia, heartburn, or jaundice. No urinary problems. Your last period was 2 weeks ago as normal. No rashes or weight loss. You can tolerate eating bread/ cereal /pasta and drinking milk normally.
Ideas, Concerns, Expectations:
You think it's from all the food you ate yesterday – you shouldn't have had those dodgy shrimps! You're worried about work; you called in sick this morning. You'd like to get a sick note for the next week.
Past Medical History:
Primary biliary cholangitis.
Drug History:
Vitamin supplements.
Allergic to penicillin (rash).
Family History:
Your uncle has Crohn’s disease.
Social History:
You work at a call centre. It's awful to work, really, but you're a single mother of two children and have always struggled with managing everything at home whilst making ends meet.
You don't smoke or drink.
Examination Findings:
Look pale
Abdomen- soft with generalised tenderness – no guarding.
Signs of dehydration: dry mucous membrane, reduced skin turgor, CRT >2 seconds…etc.
Differentials:
Gastroenteritis (Food poisoning/Infectious diarrhoea)
Irritable Bowel syndrome
Inflammatory bowel disease
Investigations:
Baseline observations
Consider stool culture + sensitivities
Considers bloods: FBC+ CRP (infection), U&Es (dehydration + electrolyte imbalance), sepsis 6 if severe with systematic features including blood culture
Consider XR abdomen in severe cases
Consider CT Abdomen/endoscopy in negative culture + persistent diarrhoea despite conservative or medical treatment to exclude other causes
Management: