General Surgery Station 2

Setting:

You are a junior doctor working in A&E. This patient has presented with abdominal pain.

Name: Sarah Forbes

Tasks:

1. Take a history from the patient.

2. State your likely diagnosis to the examiner.

3. Explain your diagnosis and management plan to the patient.

You are not required to examine the patient.

Briefing

Diagnosis: Biliary colic presenting with abdominal pain
You are Sarah Forbes and a 49yo Female.
You have presented to the Emergency Department with abdominal pain.

Appearance and Behaviour

You appear calm but are obviously in pain. You become frustrated when the candidate doesn’t give you pain-killers and starts taking a history instead.

Opening statement

“Doctor, I’m having this horrible stomach pain. I don’t know what to do, can you help me?”

Information to Give Freely

It started really badly about 2 hours ago. About 30 minutes after I had dinner, and it’s been there ever since. It’s horrible and it’s making me sick. Please can I have some painkillers now!!

Presenting Complaint

Site – RUQ abdominal pain
Onset – gradually came on about 30 mins after dinner (fish and chips)
Character – colicky and severe. It has bursts of about 30-40 mins
Radiation – goes into your epigastric (upper centre) region and round to your back too
Associated symptoms – nausea and vomiting (vomited 3 times, no blood, stomach contents)
Timing – it’s been severe the entire time so it hasn't got worse
Exacerbating/relieving factors – you think it was triggered by dinner
Severity – 9/10 when it comes on, then it fades away to about a 4/10 as baseline

Past Medical History

For the past 2 years you have had intermittent epigastric/right upper abdominal pain after eating. You assumed this was reflux and just took gaviscon for it. The gaviscon does help a bit but not completely. You have not gone to the doctor about this and have not attempted to workout a pattern with foods.
Other medical conditions - obesity
Previous surgeries - nil

Drug History

Prescribed - nil
Over the counter - gaviscon
Allergies - NKDA

Family History

None relevant

Social History

Smoking history - nil
Alcohol - 1 bottle of wine/week
Home - You live in a house with your husband and 3 children. You are a physics lecturer
Normally fully independent

Systems Review

Pain and N+V only. No other symptoms.

Ideas / Concerns / Expectation

Ideas - is this just your reflux getting worse?
Concerns - I’m worried the pain isn’t going to go away, I can’t live like this.
Expectations - I just want to be out of pain

Discussion / Questions

If the candidate does not acknowledge your pain then you can get angry. If they are kind and comfort you that we will sort painkillers as soon as possible then you calm down.