Letty's Diarrhoea

Name	Letty Apel
DOB	02/02/1986 (29 years)
Occupation	Construction worker
History	I just feel unwell with a slight fever and stomach upset. My stool has definitely been a little runnier than usual in the last week and has had a little blood mixed in. I pass stool around 3 times per day which is three times as much as I used to! I have also had awful cramping and pain but that is because of my IBS. If specifically asked, my bowel habits have been very different for the last few months with periods of constipation and diarrhoea. I have also had some nausea and weight loss of about 8–9kg. I have not been in contact with anyone unwell or eaten unusual or uncooked food. There isn't any relationship with specific foods. No other symptoms including no joint pain, rashes or eye pain. With all this going on, I feel quite low at times but IBS can't be this bad can it?
Past Medical History	Irritable bowel syndrome diagnosed a few months ago. No recent hospital admissions
Drug History	Nil. No recent antibiotic use or use of laxatives. No known allergies.
Family History	Mother has psoriasis. Nil else
Social History	Smoking 20 cigarettes per day as it helps. No alcohol or recreational drug use. 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)	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 (Inflammatory bowel disease, bacterial or parasitic gastroenteritis)	0	1

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