Patient Information - Pennine GP Training



Patient Information

You are a 67 year old Adam James, who has noticed some bleeding from your back passage when you open your bowels. It is bright red, and it looks like an awful lot of blood in your toilet water, making it red, and when you wipe your bottom.

You are sure that it is coming from your back passage alone. Your stool is also quite loose and fluidy and does smell a little. Normally you go to the toilet once a day but now going 4 x a day. Your abdomen is a little bit tender especially on the left hand side, and although you feel a little bit warm, you don’t think you have a temperature.

You are otherwise well, you have not lost any weight, and are just wondering why you keep bleeding.

If when questioned, you are specifically asked about diverticular disease, you mention that your old GP sent you to see someone a few years ago, after an episode of diarrhoea and left sided abdo pain (no blood) who said you have diverticulosis (after a colonoscopy) but you thought that it had resolved now, especially as you are eating better. You had to go to hospital at that point, and have some medicine through your arm. You were in there for about a week before you came home. They did not explain a thing!

The rest of your history is of diabetes, MI and hypertension.

You just wonder whether things are going to settle down as you thought you had been cured. You have no worries about bowel cancer as you had the screening test a few months ago and it was negative.

Married, retired and otherwise coping very well

Non smoker

Little alcohol

Plays golf 3x a week and walks the dog every morning

Ideas – Likely to be the diverticulitis again

Concerns - Might it be more serious as now there is blood?

Expectations – Does it need investigating, Do I need to go to hospital, Do I need whatever they gave me last time

Doctors Information

67 Year old man comes to see you

PMH diverticular disease, MI, Diabetes (diet controlled), and hypertension

DH – Simvastatin, Ramipril, Aspirin, Bisoprolol and Metformin

Examination Findings

GPST should examine

T37.2, P80, BP 140/80, abdomen soft, mild LIF tenderness

Observer to volunteer if GPST request rectal exam!

PR- soft brown stool on glove, some bright red blood, no masses

Marking Schedule: Positive descriptors

Data Gathering

Defines the PC

Explores ICE

Asks for lower GI ref flags and appropriate focussed questions regards PC

Takes Pulse & BP and Temp and abdo and pr exam

Makes the correct diagnosis

Interpersonal Skills

Develops rapport

Encourages patient’s contribution

Elicits patients ICE

Offers chaperone

Encourages patient’s involvement in management

Incorporates patient’s health beliefs into management plan

Ensures patients understanding

Clinical Management

Comprehensible explanation of diverticulitis

Explanation and use of an appropriate PIleaflet or web link (Contents and Relevance must be explained)

Inx (Cr&Es, FBC and CRP as a minimum) & Rx options discussed

A shared appropriate management plan – analgesia, antbx against anaerobes & gram-negative rods e.g. Co-Amoxiclav or Quinolone with Metronidazole for 7-10 days.

Explanation that symptoms should improve in 2 to 3 days

Robust safety netting

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