Patient : Mrs. C

Age : 74 years old

History of Presenting Complaint

Mrs. C was seen at the surgery on 03/09/09 complaining of changes in bowel habits. She noticed her bowel habits had become more erratic over the last few months, where she had episodes of diarrhoea alternating with constipation. In the past, she used to have problems with chronic constipation. She also noticed bright red blood in her stools which normally came towards the end of defeacation. There was no mucus in her stools, malaena, pain noted on defeacation. She complained of left iliac fossa pain which came intermittently and mostly relieved upon defeacation. Despite having tenesmus and increasingly aware of passing flatus, there was no faecal incontinence. She agreed that her haemorrhoids had become more problematic recently. But, did not notice any peri-anal ulceration.

She denied any weight loss, changes in appetite, indigestion, heartburn, haematemesis or nausea/ vomiting. She did not complain of urinary symptoms (e.g. dysuria, haematuria, frequency, urgency, incontinence, etc).

She had some problems with stiff joints mainly in her wrists, hands, knees and ankles, which were worse in the morning. She has a history of rheumatoid arthritis. Occasionally, her joints would flare up and become swollen, erythematous and painful. At present, she did not complain of any joint problems as the anti-rheumatoid medications and analgesics provided symptomatic relief and remission of her RA. However, the co-codamol does not help with her constipation.

Past Medical History