Agatha attends an Outpatient appointment at St Crispin’s Hospital having been previously referred by her GP. Agatha has ongoing symptoms of bloody diarrhoea, weight loss, and abdominal discomfort that are unresponsive to treatment. She has a 2 month history of bloody diarrhoea. Her bowels open 5-6 times per day with 1-2 nocturnal episodes. Agatha has experienced weight loss of 1 stone over the same period. She experiences a crampy left iliac fossa pain intermittently. She has no history of travel, unwell contacts or previous similar symptoms. She has longstanding mild dyspepsia for which she takes antacid as necessary. It has never been investigated. Agatha lives with her boyfriend and works as a Baker. She is an ex-smoker, stopped 2 years, and consumes 10-14 units of alcohol per week. Agatha has an allergic reaction to Amoxicillin, which presents as an urticarial rash in the form of a generalized severe rash. She first experienced a reaction aged 12 and has been told the probability of recurrence is likely.
The Outpatient Encounter
The Outpatient Encounter carried in the Encounter Resource
- Patient - Ms. Agatha Crtichard - Patient Resource
- Consultant Gastroenterologist (Document author) - Dr. Ruth Jones - Practitioner Resource
- IBD specialist nurse - Mrs. N Bryant - Practitioner Resource
- Patient’s GP (Document recipient) - Dr C. O’Reilly - Practitioner Resource
- Patient’s GP Practice - Canvas Health Centre - Organization Resource
- Hospital - St Crispin’s Hospital - Organization Resource
During the Outpatients Encounter Ruth performs a Rigid sigmoidoscopy with the assistance of nurse Bryant to the limit of view at 20cm. Which, shows inflamed and ulcerated mucosa with contact bleeding to about 15cm. Proximally appears to improve. The abdomen was found to be soft but mainly tender in the left iliac fossa. There was no guarding or rebound and bowel sounds normal.
Ruth findings suggest IBD. She changes Agatha’s medication and wants the treatment to commence today pending further investigation. She requests that a flexible sigmoidoscopy is done on an urgent basis. FBC, U&E, LFT and CRP are to be measured. Agatha is asked to provide Stool samples and given the forms and instructions how to do this.