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Chronic bowel motility problems

Clinical Discipline(s)/Organ System(s)
Digestive System, Gastroenterology & Hepatology, General Surgery, Oncology
Progress Test Topic(s)
Digestive
Description
A 35 year old South African man presents to his GP with alternating loose stools and constipation. He has not lost any weight but finds his symptoms distressing, because they have been present for a few months.
Applied Science for Medicine 
   - Anatomy of the gastrointestinal tract
   - Physiology of normal digestion and absorption
   - Pathology of coeliac disease, Crohn's disease and ulcerative colitis
   - Role of iron, vitamin B12 and folate in erythropoiesis
   - Pharmacology of loperamide, erythromycin, lactulose, metoclopramide
Clinical and Communication Skills 
   - Elicit a history from a patient with altered bowel habit; recognise 'red flag' symptoms
   - Perform and record an examination of the abdomen including rectal examination
   - Recognise depression and anxiety disorders
   - Differential diagnosis of altered bowel habit
   - Non-gastrointestinal manifestations of inflammatory bowel disease
   - Indications for endoscopy, abdominal X-ray (including plain film contrast studies), CT abdomen, ultrasound abdomen
   - Interpret coeliac disease serology, iron studies, vitamin B12/folate, faecal elastase
   - Classify irritable bowel syndrome according to the Rome criteria
   - Management of coeliac disease, irritable bowel syndrome and inflammatory bowel disease (including the use of biological therapy)
   - Complications of coeliac disease and inflammatory bowel disease
   - Prognosis of inflammatory bowel disease
   - Roles of the inflammatory bowel disease nurse specialist, dietitian and psychologist
   - Role of mindfulness meditation in irritable bowel syndrome
Personal and Professional Skills 
   - Consent for initimate examination and use of chaperone
   - Effectively communicate advice regarding lifestyle
   - Empathise with patient with chronic disease
   - Awareness of mind-body interaction in clinical conditions
Hauora Māori 
   - Cater for differential health literacy needs of Māori patients and whānau
   - Consideration of access to cultural/spiritual support for patient and whānau
Population Health 
   - Epidemiology in New Zealand of inflammatory bowel disease, irritable bowel syndrome and coeliac disease and burden of these conditions (in New Zealand and globally)
Conditions to be considered relating to this scenario
Common
irritable bowel syndrome, inflammatory bowel disease, gastroenteritis, anxiety disorder, coeliac disease, dyspepsia, drug induced
Less common but 'important not to miss'
colorectal cancer
Uncommon
pancreatic insufficiency, chronic pancreatitis, chronic ischaemic gut, carcinoid syndrome, eosinophilic gastroenteritis