Acid pain Flashcards
Introduction
- *W**ash hands
- *I**ntroduce yourself
- *P**atient’s consent
- *E**xplain procedure/purpose for Hx
PC
“What brought you in today?”
HPC
Explores pain:
First onset of pain - “when did the pain first start?”
Duration of individual episodes - “each time you get the pain, how long does it last?”
Character and location/radiation - “how would you describe the pain?”, “does it move anywhere?”
Exacerbating and relieving factors (G if asks about food getting stuck) - “does anything help with the pain?”, “does anything make it worse?”, “do you sometimes feel like food is getting stuck?”
Asks about interfering with sleep and other activities - “is the pain affecting your sleep?”, “is the pain affecting your day-to-day life? How?”
Asks about association with food and posture - “is the pain worse when you eat certain foods e.g., cheese?”, “is the pain worse when you lie flat?”
Asks about associated symptom (e.g. weight loss, vomiting, black stools) - “have you had any recent weight loss?”, “any vomiting?”, “any black stools?”
Asks about SOB and worsening on exertion - “do you feel short of breath sometimes?”, “is this worse when you exercise or go for a walk?”, “how far are you able to walk before you feel short of breath?”
Asks about symptoms of blood loss, e.g. black stools
ICE
Explores patient’s ideas about what may be going on - “what do you think could have caused your collapse?”
Elicits concern about not wanting to go to hospital - “is there anything that your worried about regarding your collapse?”
Elicits patient’s treatment expectation from the consultation - “what were you hoping we would do for you today?”
PMH
- “Do you have any medical conditions like any bowel diseases like IBS or IBD?”*
- “Do you have any heart conditions like congestive heart failure or a previous heart attack?”,*
- “Have you ever been admitted for a chest infection? Have you ever had an lung conditions like COPD?”*
- “Have you had any previous surgeries?”*
DH
“Are you on any medications that have been prescribed by your doctor?”, “do you take any over the counter medications?”
Identifies that patient has been taking ibuprofen
“Do you have any allergies to any medications? What happens when you take the medication?”
SH
Alcohol, smoking, recreational drugs (including IVDU) - “do you smoke?”, “how much do you smoke each day?”, “how long have you smoked for?”, “have you ever smoked? How much did you smoke and for how long?”(if the patient said they don’t smoke),”do you drink?”, “how much/what do you drink each day?”, “do you use recreational drugs?”, “have you ever injected drugs or shared needles with other people?”
Occupation - “do you work?”, “what do you do for work?”
Home situation - “what’s your home situation like?”, “do you need help with things like cooking, washing/cleaning yourself?”
FH
“Do you have any FHx of bowel diseases?”
Examination
Asks to examine: G if mentions appropriate examples e.g. abdominal palpation and checking conjunctivae for anaemia
“I’d like to examine you now and have a feel of your belly, have a look at your eyes and also your tongue. Is this ok with you?”
DDx
Explains what acid reflux:
“Acid reflux is when your stomach produces too much stomach acid or the pipework that prevents the acid from leaving your stomach dosen’t work as well. This stomach acid can leave your stomach and enter your gullet, which can cause it to become inflammed and painful, which could explain the pain that your getting”
Counselling
Provides lifestyle advice:
Avoid NSAIDS - “From what you’ve told me, you’re currently taking ibuprofen. I would advise that you stop taking this as it can make your acid pain worse.”
Posture, avoid spicy foods - “Also avoid lying down flat immediately after having a meal, and try not to go to bed less than 4 hours before your last meal. Spicy foods can trigger the acid pain, and I would advise that you avoid them as much as possible”
Reduce alcohol - “also reduce your alcohol consumption if you can”
Gives practical advice on management:
Suggests empirical proton pump inhibitor as trial of treatment (A if suggests ranitidine) - “in terms of medication I’ll prescribe you omeprazole which is a drug that reduces the amount of acid your stomach produces. However, common side effects of this drug are constipation, abdominal pain and dry mouth.”
Offers helicobacter stool test (G if before starting PPI, otherwise -> A) - “Before I start you on the medication, I’d like to do a stool test to check for a bacteria called Helicobacter which can cause the symptoms you’ve described”
Agrees suitable follow up if symptoms no better (within 6 weeks) - “I’d also like to see you again if the symptoms don’t get better within 6 weeks”
Mentions OGD if no improvement or if worrying symptoms - “If the symptoms don’t improve then we may have to refer you to get a camera down your throat to have a look at your stomach”
Safety-netting
Safetynetting – states appropriate review needed if red flags e.g. melaena, weight loss, severe chest pain, new SOB (at least 3 for G)
“If you get any dark brown/red stools, severe chest pain or new shortness of breath then come back to the surgery urgently or go to your nearest A&E for urgent review”
Close consultation
“Thank you so much for speaking with me today. Before you go I’d like to give you a patient information leaflet. A great website to go to is NHS choices, which I’ll write on a piece of paper for you to take home with you.”
