History-taking
CPSA · Focused history · Gastrointestinal
Change in bowel habit / diarrhoea
Characterise the change, distinguish acute (usually infective) from chronic, and screen the lower-GI cancer and IBD red flags. Ask specifically about blood and weight loss.
Focused questions
Characterise
- Frequency & consistency (Bristol), duration (acute <2 wk vs chronic), nocturnal symptoms, urgency, tenesmus, mucus
Red-flag screen
- Rectal bleeding / blood mixed in stool, unintentional weight loss, iron-deficiency anaemia symptoms, family history of bowel cancer/IBD
- Abdominal/back pain, mass
Context
- Recent travel, contacts, antibiotics (C. diff), diet, alcohol; systemic (fever); thyroid symptoms; medications
Differentials to screen
Infective gastroenteritisAcute, travel/contacts, self-limiting, ± fever
Colorectal cancerChange in bowel habit + rectal bleeding + weight loss, age >50 — 2-week-wait
Inflammatory bowel diseaseChronic bloody diarrhoea, urgency, systemic features, young patient
Irritable bowel syndromeChronic, no red flags, related to stress, relieved by defecation
Coeliac / malabsorptionSteatorrhoea, weight loss, anaemia, bloating
Red flags — exclude these
- Rectal bleeding / blood mixed in the stool
- Unintentional weight loss
- Iron-deficiency anaemia
- New change in bowel habit over 50 / abdominal or rectal mass
OSCE tips
- Explicitly ask about blood in the stool and weight loss — the key cancer red flags.
- Acute vs chronic is the first split (infective vs structural/inflammatory).
- Don’t diagnose IBS in the presence of any red flag — investigate first.