Karlene's Diarrhoea

Name	Karlene Ketcham
DOB	02/08/1989 (25 years)
Occupation	Reporter
History	I have had some diarrhoea for the last week and it smells foul. I think it is probably IBS as I have been quite stressed which has even caused me to get mouth ulcers. It is embarrassing as I cannot flush it away; it just floats. I have been feeling unwell for a while though with joint pain and fatigue. It is probably because everything just feels like it goes through me. Also I have been put off carbohydrates like breads because it makes things worse and avoiding these foods makes it better. I have not noticed any other symptoms.
Past Medical History	Anaemia. No recent hospital admissions.
Drug History	Iron tablets. No recent antibiotic use. No known allergies.
Family History	Father has Ulcerative Colitis
Social History	10 cigarettes per day. Drinks occasionally. No recent travel

Introduces self	0	1
Confirms name & age of patient	0	1
Explains reason for consultation & builds rapport	0	1
Gains consent	0	1
Asks open question	0	1
Elicits what the patient means by diarrhoea	0	1
Asks for the onset of diarrhoea	0	1
Elicits the consistency of the diarrhoea (How watery? Pellets? Greasy and hard to flush away?)	0	1
Checks colour of the diarrhoea is and asks if it smells offensive	0	1
Checks for mucus, blood or melaena in the diarrhoea	0	1
Elicits if the diarrhoea has been constant or intermittent	0	1
Elicits rough volume of stool and frequency	0	1
Checks for previous history of diarrhoea or constipation	0	1
Identifies, if present, any triggers or exacerbating factors (diet: unpasteurised dairy/uncooked meat, gluten, contact with ill person, animals)	0	1	2
Elicits any alleviating factors	0	1
Asks patient if they have ulcers, nausea, vomiting (if so, explores)	0	1
Checks if patient has had abdominal pain (reduced by defaecating?) or bloating	0	1
Asks if patient has had a change in bowel habits or increased flatulence	0	1
Checks if patient has anal pain, tenesmus or incontinence	0	1
Asks constitutional symptoms (fever, tiredness, loss of appetite, weight loss)	0	1
Asks if patient has had joint or eye pain or any rashes	0	1
Checks if patient has had recent antibiotics or hospital care	0	1
Checks for changes in periods or abnormal menstrual bleeding	0	1
Elicits past medical and surgical history	0	1
Asks if there is a family history of bowel problems including colon cancer, inflammatory bowel disease and coeliac's)	0	1
Elicits a drug history including laxative use and over the counter medication	0	1
Recent hospital admission or use of antibiotics	0	1
Checks for allergies	0	1
Elicits a social history including travel abroad (if so contact with abnormal food/animals, (if appropriate) drunk non-bottled water?), recent changes to diet	0	1
Checks if patient smokes or drinks	0	1
Explores and responds to ideas	0	1
Explores and responds to concerns	0	1
Explores and responds to expectations	0	1
Shows empathy	0	1
Avoids jargon	0	1
Summarises back to patient	0	1
Thanks patient	0	1
Patient global score	0	1	2
Gives reasonable differential diagnosis (Coeliac's disease, gastroenteritis, inflammatory bowel disease, irritable bowel syndrome)	0	1

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