GP CCE Cases · gastrointestinal-health
Acute gastroenteritis — CCE clinical encounter
CCE-style clinical encounter: a dehydrated 42-year-old with three days of diarrhoea and vomiting from a family outbreak, demanding 'something to stop it'. The candidate must assess dehydration systematically, manage with ORS, resist inappropriate loperamide and antibiotics, and safety-net effectively.
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Target exams
RACGP CCEFRACGP oralsCFPC SOOs
Prompt
A 42-year-old mother of three attends at the end of a Saturday clinic: three days of watery diarrhoea and vomiting since a family barbecue. She is pale, has mild thirst and reduced urine output, and is looking after three sick children alone. She wants 'something to stop it' because she cannot keep taking time off work.
Objectives
- Assess dehydration systematically rather than by gestalt — structured scoring per NIRUDAK validation. [2]
- Screen red flags: blood, fever, recent antibiotics, travel. [7]
- Prescribe ORS with practical dosing and manage her work-pressure reality honestly. [2]
- Counsel on symptom agents: racecadotril over loperamide for infectious diarrhoea; avoid loperamide if blood or fever appears. [4]
- Safety-net with specific return triggers and document the plan.
References5ShowHide
- [2]Levine AC, Gainey M, Qu K et al. A comparison of the NIRUDAK models and WHO algorithm for dehydration assessment in older children and adults with acute diarrhoea: a prospective, observational study. The Lancet. Global health, 2023.PMID 37776870
- [4]Aziz M, Malik LU, Javed E et al. Racecadotril Versus Loperamide for Acute Diarrhea of Infectious Origin in Adults: A Systematic Review and Meta-Analysis. Health science reports, 2025.PMID 40415979
- [7]Fischer M, Vaughn BP, Peery AF et al. AGA Clinical Practice Update on Management of Clostridioides difficile Infection in Adults: Expert Review. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 2026.PMID 42383946
- [8]Donskey CJ Update on Clostridioides difficile Infection in Older Adults. Clinics in geriatric medicine, 2026.PMID 42547174
- [3]Johns T, Lawrence E Evaluation and Treatment of Nausea and Vomiting in Adults. American family physician, 2024.PMID 38804756