Tuesday, September 6, 2011

CASE 5: Standard Consult Alcohol Problem (8 mins)



Name:  Joe Smith
Age: 35
Sex: Male
Occupation: Forklift driver
Social history: Married with 2 young children under 5yo

Presented with alcohol problem and his wife asked him to see you to sort things out or "it is over" between them.



Things to think about....

In your 3mins....
???what is the possible problem list
???what notes are you going to put down
???what examination findings are you interested in eliciting
???what are the possible investigations you may need to order
???how are you going to manage this

(To answer please click on comment section)



8 comments:

  1. This comment has been removed by a blog administrator.

    ReplyDelete
  2. possible problem list -
    1. adverse effect of alcohol including physical effects and psychological and social issues, such as liver damage, GI symptoms, CVS problem, brain damage, insomnia, depression/anxiety, relationship problem, sexual dysfunction
    2. road safety , safety of working as a forklift driver, safety of driving
    3. the effect of his excessive alcohol drinking on his children
    4. finance issue,

    what notes are you going to put down -
    In addition to routine Hx, P/E, I would particularly advise the safety of driving issue, I would advise not to drive (both private and work as a forklift driver) if the history and physical examination indicate he is not safe to drive.

    what examination findings are you interested in eliciting-

    1. CAGE, expect to have positive answers
    2. red puffy face, red eyes, alcohol smelling, telangiectasia, rosacea
    3. possible jaundice, palm erythema, wasting of thena, spider naevus, bruise, gum bleeding, epistaxis, tremor, poor balance
    4. arrhythmia, HTN. obesity
    4. enlarged liver or spleen, ascites
    5. depressed mood, anxious,

    what are the possible investigations you may need to order-
    FBC, LFT, UEC, Vit B12, folate, fasting lipids and glucose, ECG, USS abdo
    May need CXR, gastroscopy
    Blood alcohol level

    how are you going to manage this -
    1.supportive and nonjudgmental, better including wife to support him, refer to ATODS, AA meeting

    2.assess the degree of risk asso with his alcohol drinking level and give feedback, and outline the benefit of reducing drinking

    3.assess readiness of change

    4.set goals of alcohol consumption and work out strategies to achieve the goals

    5.regular F/U or phone call F/U
    6.give thiamine and Vit B complex
    7.Manage alcohol induced/related illness, may need specialists help – gastroenterologist, cardiologist, Psychiatrist
    8.Manage withdrawal and hangover symptoms

    Tricia

    ReplyDelete
  3. possible problem list -
    1. adverse effect of alcohol including physical effects and psychological and social issues, such as liver damage, GI symptoms, CVS problem, brain damage, insomnia, depression/anxiety, relationship problem, sexual dysfunction
    2. road safety , safety of working as a forklift driver, safety of driving
    3. the effect of his excessive alcohol drinking on his children
    4. finance issue,

    what notes are you going to put down -
    In addition to routine Hx, P/E, I would particularly advise the safety of driving issue, I would advise not to drive (both private and work as a forklift driver) if the history and physical examination indicate he is not safe to drive.

    what examination findings are you interested in eliciting-

    1. CAGE, expect to have positive answers
    2. red puffy face, red eyes, alcohol smelling, telangiectasia, rosacea
    3. possible jaundice, palm erythema, wasting of thena, spider naevus, bruise, gum bleeding, epistaxis, tremor, poor balance
    4. arrhythmia, HTN. obesity
    4. enlarged liver or spleen, ascites
    5. depressed mood, anxious,

    what are the possible investigations you may need to order-
    FBC, LFT, UEC, Vit B12, folate, fasting lipids and glucose, ECG, USS abdo
    May need CXR, gastroscopy
    Blood alcohol level

    how are you going to manage this -
    1. supportive and nonjudgmental, better including wife to support him, refer to ATODS, AA meeting

    2. assess the degree of risk asso with his alcohol drinking level and give feedback, and outline the benefit of reducing drinking

    3. assess readiness of change

    4. set goals of alcohol consumption and work out strategies to achieve the goals

    5. regular F/U or phone call F/U
    6. give thiamine and Vit B complex
    7. Manage alcohol induced/related illness, may need specialists help – gastroenterologist, cardiologist, Psychiatrist
    8. Manage withdrawal and hangover symptoms


    Tricia

    ReplyDelete
  4. What else is important to include in the problem list/DDX?

    ReplyDelete
  5. DEAR TRICIA ,
    fOLLOWING MY LAST COMMENT REGARDING ASKING FOR A PARTNET FOR ROLE PLAYING.my,email is IMANBAHREINI@YAHOO.COM
    I talked to Dr Tran already about it.
    cheers

    ReplyDelete
  6. Other problem lists-
    recreation drug use
    smoking
    healthy diet, exercise
    immunisation

    tricia

    ReplyDelete
  7. Should you include Depression and Anxiety as part of your possible Differential Diagnosis and if so why?

    Dr Vinh Tran

    ReplyDelete
  8. Yes, they might be the cause other than consequences

    Tricia

    ReplyDelete