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GI History-takingLearning outcomes ▶ Understand what a history-taking station entails ▶ Understand a general structure of history-taking, and applying this to GI ▶ Appreciate the variety of symptoms to enquire about ▶ Name some GI red flag symptoms What is a history-taking station? ▶ Clinical scenario ▶ Involves exploring a patient presentation ▶ Gaining a better understanding of the situation and the patient as a whole ▶ Addressing patient concerns or questions ▶ Coming up with a brief plan together General points ▶ WINDEC ▶ Remember general communication skills ▶ Open → closed questions ▶ Avoid jargon ▶ Chunk and check ▶ Ask for questions/anything missed ▶ Safety-nettingHistory-taking structure example 1. Introduction 2. Presenting complaint/History of presenting complaint 3. Systemic enquiry 4. Past medical/surgical history 5. Drug history and allergies 6. Family history 7. Social history 8. ClosingUpper GI Symptoms ▶ Jaundice → hepatitis, liver cirrhosis and biliary obstruction (e.g. gallstone, pancreatic cancer). ▶ Mouth ulcers → deficiencies, Crohn’s, cancer ▶ Vomiting → infection, GORD, obstruction ▶ Haematemesis → Mallory-Weiss tear, oesophageal varices, ulcer ▶ Retrosternal burning → GORD ▶ Dysphagia → cancer ▶ Odynophagia → oesophageal stricture, infectionLower GI Symptoms ▶ Abdo pain → see later ▶ Bowel habit ▶ diarrhoea → infection, IBD, IBS, drugs, constipation ▶ constipation → dehydration, obstruction, drugs ▶ steatorrhoea → pancreatic, biliary ▶ Blood in stool ▶ Melaena → upper GI bleed ▶ Fresh blood → haemorrhoids, fissures ▶ Distension → fluid, solid, gas Abdo pain - SOCRA TES ▶ Right iliac fossa ▶ Left iliac fossa ▶ Epigastric pain ▶ Right upper quadrant pain ▶ Flank pain ▶ Suprapubic pain Abdo pain - SOCRA TES ▶ Right iliac fossa pain - appendicitis, Crohn’s, ovarian torsion, ectopic ▶ Left iliac fossa - diverticulitis, ovarian torsion, ectopic ▶ Epigastric - GORD, gastritis ▶ Right upper quadrant - biliary, hepatitis, pancreatitis ▶ Flank - renal (kidney stones, pyelonephritis) ▶ Suprapubic - UTI Travel history ▶ Where? ▶ malaria, campylobacter, shigella, G.Lamblia, Salmonella typhi/paratyphi ▶ Who? ▶ similar symptoms? ▶ Insects? ▶ Diet and hydration? ▶ High-risk foods ▶ Contaminated water ▶ Swimming Recent exposure ▶ Sex and pregnancy ▶ Foods ▶ Animals/petting zoos ▶ Antibiotics ▶ Family/friends/social Risk factors ▶ GI disturbances ▶ FH ▶ Alcohol ▶ Smoking ▶ Certain prescribed drugs ▶ Recreational drugs ▶ DietGI Explanation and Advice Learning outcomes ▶ Understand what an ‘Explanation and Advice’ station entails ▶ Outline the general structure of an ‘Explanation and Advice’ station ▶ Understand the key points in communication with patients ▶ Practice applying knowledge to cases of IBD and IBS What is ‘Explanation and Advice’? ▶ Clinical scenario ▶ Involves explaining a condition to someone who may never have heard of it before ▶ Addressing patient concerns or questions ▶ Coming up with a plan together ▶ As much about information giving as information gatheringCOMMUNICATION AND STRUCTURE IN E&AIntroduction ▶ Proper introductions are key ▶ Wash hands ▶ Who you are - name, role ▶ Confirming patient identity ▶ Clarifying purpose of consultation ▶ Check patient understanding of today’s meeting ▶ Explain agenda ▶ Consent Throughout the consultation ▶ Avoid jargon and complicated language ▶ Always check patient understanding before giving information ▶ Non-verbal communication and cues ▶ ICE Closing ▶ Chunk and check ▶ Always give the opportunity for questions ▶ Resources and safety-netting ▶ Thank patient for timeStructuring an E&A consultationCrohn’s explanation and adviceNormal anatomy ▶ What happens in your gut ▶ Anything you consume travels from your mouth and through your gut, where food is broken down and all the nutrients absorbed ▶ All waste is filtered out and excreted in faeces ▶ Importance of healthy functioning ▶ All those nutrients are essential to provide fuel for the body ▶ Sometimes our gut doesn’t function as well as it shouldWhat happens in Crohn’s? ▶ Epidemiology ▶ common (1-2/1000/yr) ▶ typically presents around 20-40 years old ▶ Anatomy ▶ type of IBD ▶ chronic ▶ can affect any part of the GI tract (mouth to anus) ▶ inflammation of the lining of the gut ▶ can deepen with time, causing ulcers, thickening of the lining of the bowel, fistulae and fissures → can be detected on endoscopyWhat you might notice ▶ General GI symptoms ▶ abdo pain, especially in RIF ▶ abnormal stools: diarrhoea, bloody, mucous ▶ N&V ▶ Fatigue ▶ Weight loss ▶ Specific GI symptoms ▶ mouth ulcers ▶ perianal diseaseCauses of Crohn’s ▶ Unclear ▶ Genetics ▶ Environmental trigger ▶ Lifestyle factors Risk factors ▶ Family history ▶ Smoking ▶ Gastroenteritis ▶ NSAIDs ▶ Diet ▶ low fibre ▶ high refined sugarsComplications ▶ Non-GI symptoms ▶ eye problems (e.g. uveitis) ▶ arthritis ▶ B12 deficiency/anaemia ▶ rashes (e.g. erythema nodosum) ▶ kidney stones ▶ hepatobiliary manifestations (e.g. PSC, gallstones) Management ▶ Chronic with relapsing-remitting course and no cure ▶ Aim to induce and maintain remission ▶ Will treat flare ups as needed ▶ Non-medical ▶ Stop smoking ▶ Avoid triggers and maintain healthy diet ▶ Healthy lifestyle including low alcohol and regular exerciseManagement ▶ Medical ▶ Inducing remission with steroids/aminosalicylates ▶ Other meds can be added if required (thiopurines, methotrexate, biologics) ▶ Thiopurines to maintain remission ▶ Extra steroids in flares ▶ Regular reviews ▶ Surgical ▶ Usually if severe or development of complications ▶ NOT CURATIVEIBS explanation and adviceNormal anatomy ▶ What happens in your gut ▶ Anything you consume travels from your mouth and through your gut, where food is broken down and all the nutrients absorbed ▶ Gut bacteria are balanced to help your gut function ▶ All waste is filtered out and excreted in faeces ▶ Importance of healthy functioning ▶ All those nutrients are essential to provide fuel for the body ▶ Sometimes our gut doesn’t function as well as it should ▶ Imbalance of bacteria can produce unpleasant symptomsWhat is IBS? ▶ Epidemiology ▶ Very common ▶ Usually appears aged 20-30 years (females more commonly affected) ▶ Breakdown of name ▶ Explain acronym ▶ “Irritable” = sensitive to triggers ▶ Typical triggers ▶ stress ▶ caffeine ▶ alcohol ▶ spicy and fatty foodsWhat you might notice ▶ Main symptoms ▶ changes to bowels ▶ diarrhoea ▶ constipation ▶ bloating ▶ abdominal painCauses of IBS ▶ Uncertain (“medically unexplained symptoms) ▶ Disturbance of gut flora ▶ Genetics ▶ Stress ▶ Links to previous gut issues/sensitivities Complications ▶ Does not cause IBD or cancer ▶ Psychosocial impacts ▶ Dehydration ▶ Very manageable often with limited complicationsManagement ▶ Non-medical (mainstay of treatment) ▶ Food diary to help recognise and avoid triggers ▶ Lifestyle modifications including healthy diet and exercise ▶ Stay hydrated ▶ Mindfulness and self-guided relaxation ▶ Medical ▶ treat symptoms (e.g. laxatives, antidiarrhoeal) ▶ Consider need for psych interventionQUESTIONS?Feedback Please take a minute now before you leave to fill in a quick feedback form! https://app.medall.org/feedback/feedback-flow?keyword=cf72c2 d3320f449e64a53676&organisation=accessibility-in-medicineImages https://images.pexels.com/photos/7176317/pexels-photo-7176317.jpeg?auto=co mpress&cs=tinysrgb&w=1260&h=750&dpr=2 https://geekymedics.com/explaining-a-diagnosis-of-asthma-osce-guide/ https://images.pexels.com/photos/5206940/pexels-photo-5206940.jpeg?auto=co mpress&cs=tinysrgb&w=1260&h=750&dpr=2 https://images.pexels.com/photos/5712686/pexels-photo-5712686.jpeg?auto=co mpress&cs=tinysrgb&w=1260&h=750&dpr=2 https://images.pexels.com/photos/3683053/pexels-photo-3683053.jpeg?auto=co mpress&cs=tinysrgb&w=1260&h=750&dpr=2 Thank you for coming! ▶ If you have any more questions, feel free to email me at s1915023@ed.ac.uk or email accessibilityinmedicine@gmail.com ▶ Give our Facebook page a like for updates and opportunities, just search @AIMEdinburghSign up to the mailing list ▶ Sign up to the AIM mailing list to be the first to hear about tutorials, discounts, and opportunities! ▶ https://forms.gle/qJ NyeoFzA9B5urND7Thank you to our sponsors