GASTROENTEROLOGY

GASTROENTERITIS

Introduction

5 min

Introduce yourself and the group

Provide rationale for the session and relevance to clinical practice

Outline learning objectives:

Demonstrate structured history-taking and examination technique on a patient with suspected gastroenteritis
Suggest five differential diagnoses for diarrhoea and vomiting
Understand initial management of a patient presenting with gastroenteritis
Understand components of common IV fluids and prescribe IV fluids appropriately for a patient with gastroenteritis

Explain structure of session

Total time:

60 min

Number of students:

1-5

Grade of students:

3rd to 5th year medical students

Created by:

Dr Charlotte Hayden

Uploaded:

29th October 2019

Last updated:

29th October 2019

Resources needed for this session:

Prescription chart, pen, paper, bags of common IV fluids e.g. Hartmann's, normal saline

Resources linked to this session:

None

Activity 1: History Taking

10 min

Ask the student(s) to take a focused history from a patient presenting with possible gastroenteritis. Include presenting complaint, past medical history, drug history and social history. Remember to encourage appropriate personal protective equipment and infection control policy.

This can be observed if capacity of tutor allows.

Activity 2: Case-Based Discussion

10 min

Ask the student(s) to present their history. Feedback on presentation style (max 1 min).

Ask:

What differential diagnoses have you considered? What are the causes of infective gastroenteritis?
What investigations would you consider?

Activity 3: Initial Assessment

15 min

Ask the student(s) to examine the patient using a structured ABCDE approach. Following this, debrief and discuss:

How would you assess and begin basic management of this patient?
What findings in your assessment might suggest this patient is more unwell?

Activity 4: Applied Clinical Science

10 min

Discuss normal fluid distribution and daily maintenance fluid and electrolyte requirements for an average person. Ask the student(s) to calculate fluid, sodium and potassium requirements for the patient they have seen.

Discuss stages of shock. Consider drawing the blank table opposite on a whiteboard and highlight the key values. Allow the student(s) to view the notes for the patient they have seen and ask them to grade the degree of hypovolaemic shock.

Summarise the concept of resuscitation vs. maintenance fluid requirements.

Activity 5: Prescribing

10 min

Find a few bags of common IV fluids. e.g. Hartmann's, normal saline and dextrose. Allow students to see them and look at the constituents of each bag.

Ask the student(s) to find a drug chart. Using their calculations above, ask the student(s) to prescribe the following:

Appropriate resuscitation fluids that would have been given at initial presentation.
Appropriate maintenance fluids for 24 hours following initial resuscitation.

Give feedback on choice/rate of fluids prescribed.

Activity 6: Further Management

5 min

Ask the student(s) to find the local infection control protocol for patients with infective gastroenteritis.

Consider:

Have all the relevant precautions been taken with respect to this patient?
How might you manage an outbreak of gastroenteritis on a ward?
Which professionals would need to be involved in managing an outbreak of gastroenteritis on a ward
What would be their role(s)?

Summary and Feedback

5 min

Questions

Identify and summarise key learning points (key three points if possible)

Feedback to student – highlight further learning needs

Feedback for teacher - ask students to provide feedback using the QR code opposite

References and Further Reading

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