Tutorial 7: Case 2

Question 1

Andrea, 26 years old, looks uncomfortable. She asks ‘Can I have something for a sore stomach please’

A) Who is it for?

B) What are the symptoms?

C) How long have you had these symptoms?

D) Action taken

E) Medications being taken?

F) Medical conditions

G) Allergies

H) P/BF (female asking…)

Answer 1

A) Myself or say –> ‘since it’s for yourself, what are the symptoms’

B) I have cramps in my lower belly and some bloating

C) A few days, they are quite bad today

D) Peppermint oil capsules which are giving me a bad heartburn

E) I take probiotics to try and help with my gut health

F) I have always had a stomachache and bloating. After a lot of testing my GP has said I have irritable bowel syndrome.

G) Only food intolerances, what, fructose. I follow a low FODMAP meal plan.

H) no

Question 2

Appropriate extended questions

1. Are there any other symptoms including diarrhea, constipation, blood or mucus in stool.
2. Is this similar to previous episodes of IBS?
3. Are the cramps associated with bowel movements?
4. Any systemic symptoms- fever, malaise?
5. Has anything changed recently? Any activities?

Answer 2

1. Stools not as formed as they usually are, though I would say it is bad diarrhea and there is no blood or anything else in them.
2. Yes, it is the same as I have previously experienced with IBS
3. Yes, they appear before I need to go and seem to be relieved once I have emptied my bowel.
4. No just discomfort and general symptoms in that area
5. I have been eating out a lot the past fortnight due to a few birthday celebrations.

Question 3

What is the diagnosis? Explain reasoning to patient.

Answer 3

Based on the signs and symptoms you have told me along with the diagnosis by your doctor, I believe you do have irritable bowel syndrome (IBS). Symptoms such as the cramping in your lower belly and the bloating are common symptoms of IBS. Most likely triggered by you eating out over the past fortnight which has irritated your stomach.

Question 4

What product would you recommend for this patient? Provide IDARL.

Answer 4

Hyoscine butylbromide (buscopan)

• Indication: Since the cramps bother you the most, this medication will help stop the cramping pain as well as the bloating in the stomach by relaxing the muscles in your stomach
• Dose and directions: Take 1 tablet four times a day
• Adverse effects: generally well tolerated, may cause constipation, dry mouth, and blurred vision.
• Duration of treatment, time to recovery, When to refer: Don’t take for longer than 2 weeks. I will refer you to a doctor if the pain worsens, if you get a fever, if there is blood in your stools (also unexplained weight loss)
• Lifestyle/self-care: limit foods high in fat, sugar or salt. Exercise for at least 30 minutes a day. Limit alcohol intake.

I will give you a self care-card for IBS and a consumer medication information leaflet. Do you have any questions for me?