Gastrointestinal Flashcards
Scenario: You are working as a psychiatry trainee in an outpatient Alcohol and Drug service of a large hospital, doing a regular outpatient session. You are reviewing Matthew, a 28 year old solicitor, for the first time. He has been referred by the Consultation-Liaison Service, who saw him one week ago after he inadvertently took an accidental heroin overdose in the context of alcohol intoxication whilst at a party, thus requiring a brief inpatient stay on a medical ward. He has a past history of alcohol abuse and heroin dependence, although states that he has not regularly used either over the last 3 years, since graduation and commencing full-time work. He uses IV “speed” at parties occasionally.
At the commencement of the interview Matthew will inform you that he has had the last 2 days off from work with abdominal pain.
Focussed history:
Pattern of symptoms – time-course, site of pain, nature of pain, radiation of pain, relieving factors, aggravating factors, nausea, vomiting, diarrhoea, fevers, & level of role impairment.
Screen for causes – ask about recent substance use, sexual and intimate contacts, travel, fatigue, bleeding/easy bruising, dark urine and light coloured stools, joint pains, skin rashes.
Tailored examination:
The composition of the examination and the technique are both being assessed. A full abdominal examination will include the following and use the examination couch.
