Morning fellow medics,

I hope that you are all well and safe in whichever part of the World you are in. I have followers and readers from different aspects of the globe which proves how universal medical education is. It is great to see you all checking out my social media and blog posts.

Moving onto the aim of the post - lets have a look at ‘red flags’ in gastroenterology. These are symptoms that the patient will present with (maybe a single symptom or multiple) which warrants further investigation or a two week wait referral (cancer referrals by which the patient has to be seen within 2 weeks).

As always stated: below is just a summary and the list is not exhaustive. The aim of this blog is not to teach you new material, but to remind you and a trigger to get you thinking.

Weight loss

Weight loss is a red flag in any system, with the all important question being whether it is intentional or unintentional. Weight loss may also be a manifestation of a lack of appetite (which is also a worrying feature). Find out how much weight loss has occurred and in what amount of time.

Dysphagia

Difficulty in swallowing can mean many things, so knuckle down what the patient means. Is it that the food is getting stuck? Is it indigestion? If food it getting stuck, get an idea of the course of symptoms, did it start as solids and now its fluid? (which would indicate progression of symptoms/occlusion). This is where your history taking skills come into action

Dyspepsia

Dyspepsia itself is not an issue, as we all have had dyspepsia time to time (indigestion). It becomes an issue when faced with age + worsening symptoms. If you have a 60 year old man come in with new onset of dyspepsia that is getting worse, this may be different to a 40 year female with a poor diet/lifestyle, who has a bit of heart burn in the evening.

Change in bowel habits

A change in bowel habit needs to explored in detail - is it looser? Is the patient opening their bowel more often or less often? How long have the symptoms been present? A short episode of loose bowels is not as worrying as a long history of diarrhoea plus waking up in the night to open bowels. Do not forget that constipation is also an alarming symptom.

Per rectal bleeding

Ask about the colour of the blood- bright red or dark red. Is the blood mixed in with the stools or on the surface of the stools (giving you an indication of the location of the bleed). Ask about pain on defecation, which may indicate a fissure. Per rectal bleeding is a concerning symptom for a patient, but can be embarrassing, so ask these questions sensitively.

Abnormal investigations: high platelets or new low haemoglobin

Both of these are a cause for concern. High platelets are indicative of inflammation which may be due to cancer and a low haemoglobin may indicate a bleed from the GI tract.

I hope that the list above gave you a reminder of some red flags in gastroenterology to get you thinking. An excellent resource to be familiar with is CKS NICE - it has a summary of the NICE guidelines and also has a section on red flags in gastroenterology. Click link to check it out.

If you are interested in having one to one revision (or even join forces with a friend) please check out the website for further information.

Best of luck in the upcoming SJT!

L x