Change In Bowel Habit

Question 1

Sequence of events

Answer 1

Open question- tell me more
Timeline- when did it start/ how has it progressed
Timing- has it happened before/ if so when

Question 2

Symptom analysis

Answer 2

Clarify- what do you mean? Had consistency changed or are you going more or less frequently
Frequency- how often do you normally Koenig your bowers. What is normal for you?
Character/ colour- what are your motions like? Watery, semi solid, achy mucus in stools or tissue paper, colour?
Malaena- any dark, foul smelling stools?
Exacerbating or relieving factors?- does anything trigger the events? Anything make it better?
Tenesmus- do you feel like you always need the toilet, even after you’ve been? Is this despite not passing much stool?

Question 3

Systems review

Answer 3

FWARJNL Tiredness (anaemia)

GI- vomiting, nausea, pain, bloating, flatus, haematemesis, dysphagia, reflux or indigestion
NS- any back pain, weakness in legs
Foreign travel recently

Question 4

Colon cancer

Answer 4

55+ (unless FH)
Red flag symptoms
Consider in men and non menstruating women with unexplained iron deficiency anaemia
Previous history of malignancy and inflammatory bowel disease (coealiac)

Question 5

Gastroenteritis

Answer 5

History of risk factor eg, uncooked food, travel etc.
Acute diarrhoea (watery, loose, bloody etc)
N and v
Household members may also be unwell

Question 6

IBD

Answer 6

Blood or mucus in stool
Abdominal pain
Fever mouth ulcers anorectal disease and extraintestinal Sx
Weight loss

Question 7

IBS

Answer 7

Fluctuate between diarrhoea and constipation
Anxious personality/ associated with stress
Crappy abdominal pain and bloating
Pain relieved on passing a motion
No blood in stools or other red flags

Question 8

Coeliac disease

Answer 8

Diarrhoea
Steatorrhoea
Anaemia symptoms
Abdominal discomfort

Question 9

Thyrotoxicosis

Answer 9

Diarrhoea 
Heat intolerance 
Irritability 
Tremor 
Oligomenorrhoea

Question 10

Hypothyroidism

Answer 10

Constipation
Cold intolerance
Lethargy
Menorrhagia

Question 11

Others

Answer 11

Obstruction (not passing flatus)
Opiates (constipation)
Lactose intolerance 
Diverticulitis 
Clostridium (recent ABX)
Calcium abnormalities 
Faecal impact ion- overflow diarrhoea
CMV diarrhoea in HIV

Question 12

Patients perspective

Answer 12

Feeling and effect on life

Ideas concerns expectations

Question 13

PMH

Answer 13

Anaemia, IBD, previous malignancy

Question 14

DH

Answer 14

Laxatives, anti diarrhoea’s, analgesics eg. Coedine

Question 15

FH

Answer 15

IBD, malignancy (colorectal and OVARIAN)

Question 16

SH

Answer 16

Smoking alcohol recreational drugs
Job
Home life

Question 17

Factors causing constipation

Answer 17

Diet- low fibre, processed or ready meals, reduced water intake
Lack of exercise and immobility
Medication- opioids, iron supplements etc.
Anorectal disease eg. Fissures that make defecation painful

Question 18

Diverticular disease

Answer 18

Middle aged elderly patients with bloody diarrhoea and pain in left illiac fossa
Diverticulitis- fever, nausea, vomiting
Risk factors- obesity and low dietary fibre

Question 19

Malabsorption

Answer 19

Eg, due to coeliac disease, chronic pancreatitis, thyroid disease, diabetes
Steatorrhoea, weight loss, general malaise

Question 20

Investigations

Answer 20

Full abdo exam and PR exam
FBC LFT UE TFT CRP ESR coeliac screen
Stool culture 
Faecal occult blood 
AXR
Colonoscopy, endoscopy 
Abdominal CT