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3002 > 3 History taking: abdomen > Flashcards

3 History taking: abdomen Flashcards

1
Q

Medical history structure

A
  1. Presenting complaint
  2. History of presenting complaint
  3. Past medical history
  4. Drug history (including allergies)
  5. Family history
  6. Social history
  7. Systems enquiry/review (remaining systems: CVS, RS, Endocrine, MSK, CNS, GU)
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2
Q

History of presenting complaint Gastrointestinal (abdomen) questions

A
  • Abdominal pain
  • Anorexia and weight change
  • Dyspepsia / Indigestion
  • Dysphagia
  • Nausea and vomiting
  • GI tract bleeding
  • Jaundice
  • Change in bowel habit – constipation / diarrhoea
  • Look out for ‘Red Flags’!
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3
Q

What are the questions to ask regarding pain?

A
  • Does it stop them doing anything?
  • Are they lying still or writhing around?
  • Do symptoms tie in with signs? – Does what they say fit with how they look?
  • Aide memoire of SOCRATES - Site, onset, character, radiation, associated symptoms, timing, exacerbators/relievers, severity
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4
Q

What are the names of the 9 regions for identifying pain?

A
  • Right hypochondrium
  • Epigastric region
  • L hypochondrium
  • R flank/ lumbar region
  • Umbilical region
  • L flank/ lumbar region
  • R iliac fossa
  • Hypogastric/ suprapubic region
  • L iliac fossa
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5
Q

What are the names of the 4 quadrants?

A
  • Right upper quadrant
  • Left upper quadrant
  • Right lower quadrant
  • Left lower quadrant
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6
Q

What condition do the following pain radiations suggest:
– Radiation to the back
– Shoulder tip
– Radiation from loin to groin

A
  • Radiation to the back – pancreatitis
  • Shoulder tip- diaphragmatic irritation
  • Radiation from loin to groin- renal colic (kidney stone)
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7
Q

What are the associated symptoms relating to GI pain? (5)

A
  • Sweating / Fevers
  • Vomiting /nausea
  • Diarrhoea
  • Urinary symptoms
  • Vaginal bleeding / discharge

**Ask about WEIGHT LOSS

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8
Q

What are the common exacerbators (4) and relievers (4) for GI pain?

A 
• Common exacerbating factors:
– Eating/ not eating
– Movement/ lack of movement
– Position
– Exercise (think cardiac disease)
• Common relieving factors: 
– Eating/ not eating
– Movement/ lack of movement
– Position
– Vomiting/ opening bowels
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9
Q

What could be colicky RUQ pain?

A

Gallstones

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10
Q

What is epigastric pain with associated mass and dysphagia

A

Gastric carcinoma

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11
Q

Define anorexia?

A

Reduction in appetite +/or lac of interest in food

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12
Q

4 causes of weight gain

A 
1. Fluid gain e.g. cardiac failure, liver disease, nephrotic
syndrome
2. Hypothyroidism
3. Depression
4. Increased energy input/ output ratio
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13
Q

5 causes for unexplained weight loss

A
  1. Malignancy
  2. Malabsorption e.g. chronic pancreatitis / coeliac disease / Crohn’s disease
  3. Metabolic diseases e.g. diabetes, hyperthyroidism, renal disease, chronic infection (TB/ HIV)
  4. Psychiatric causes e.g. depression / dementia / anorexia nervosa
  5. Malnutrition
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14
Q

Dyspepsia?

A

Indigestion

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15
Q

What are the symptoms of dyspepsia?

A
  • Heartburn
  • Acidity
  • Pain
  • Discomfort
  • Nausea
  • Wind
  • Fullness
  • Belching
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16
Q

What makes dyspepsia better or worse?

A
  • Usually triggered by food

* May be relieved by antacid/ “Gaviscon”

17
Q

What is dyspahgia?

A
  • Difficulty in swallowing

* Can be confused with ‘globus’ sensation

18
Q

Causes of dysphagia:

  1. Oral (2)
  2. Neurological (2)
  3. Neuromuscular (4)
  4. Mechanical (5)
A
  1. Oral:
    • Painful mouth ulcers
    • Tonsillitis / pharyngitis / glandular fever
  2. Neurological:
    • CVA
    • Bulbar or pseudobulbar palsy
3. Neuromuscular:
• Achalasia
• Pharyngeal pouch 
• Myasthenia Gravis
• Diffuse oesophageal spasm
4. Mechanical:
• Oesophageal carcinoma
• Peptic oesophagitis
• Benign stricture
• Extrinsic compression (e.g. lung tumour, lymph nodes, goitre)
19
Q

What is haematemesis?

Causes?

A 
• Vomiting blood - fresh red or 'coffee-ground'
• Causes: 
– Gastric/duodenal ulcer** 
– Gastric erosions
– Varices
– Mallory-Weiss syndrome
– Reflux oesophagi's
– Gastric carcinoma
20
Q

What is the commonest cause of serious and life-threatening GI bleeding?

A

Peptic ulceration

21
Q

What is melaena?

Causes?

A
  • Malaena - passage of black tarry stools
  • Usually secondary to bleed in oesophagus, stomach or duodenum
  • Caused by peptide ulceration

• Stools will also appear dark when taking oral iron

22
Q

What are the 2 signs of upper GI tract bleeding?

A
  1. Haematemesis

2. Malaena

23
Q

Sign and cause of lower GI bleeding?
Questions to ask?
Associated symptoms?

A

• Usually fresh red blood

• Questions to ask:
– Duration and frequency? / Is it mixed with stool? / associated symptoms?

• Associated symptoms
– E.g. Diarrhoea, constipation, abdominal pain, change in bowel
habit, weight loss, rectal / anal pain

• Causes
– Haemorrhoids / anal fissure / diverticular disease / large bowel polyps or carcinoma / inflammatory bowel disease

24
Q 
Jaundice:
• What is it?
• Causes?
• Questions to ask?
• Painless jaundice suggests..
A

• Yellow discolouration of sclerae / skin

• Causes:
– Pre-hepatic/ Hepatic/ Post-hepatic

• Questions to ask:
– Duration/ associated symptoms (pain, weight loss, fevers) / Colour of stool and urine / Travel / Consumption of shellfish / Blood transfusion / Alcohol consumption / Changes in medication / Intravenous drug use / Unprotected sex

• N.B. Painless jaundice suggests carcinoma of head of pancreas

25
Q

When to investigate persistent change in bowel habit?

Questions to ask?

A

• > 4 weeks

• Questions to ask:
– ‘Has there been any change in your bowel habit?’
– Duration
– Colour of stool – mucous / fresh or altered blood
– Constipation/ diarrhoea, or mixture of both
‘In what way?’
– Associated symptoms e.g. pain / nausea or vomiting / weight loss / appetite / tenesmus (feeling of not fully emptying bowels)
– Changes in diet or medication/ other illnesses

26
Q

What are common causes of constipation?

A 
– Diet/ dehydration
– Painful anal conditions (e.g. anal fissure)
– Immobility
– Medication e.g. opiates
– Hypothyroidism
– Colonic / rectal carcinoma
– Neuromuscular e.g. spinal cord disease / Parkinson’s disease – Hypercalcaemia (may be related to malignancy)
– Irritable bowel syndrome
27
Q

What are common causes of diarrhoea?

A

– Diet
– Stress
– Infection e.g. viral gastroenteritis / food poisoning
– Inflammation e.g. ulcerative colitis / Crohn’s
– Endocrine e.g. hyperthyroidism
– Malabsorption e.g. coeliac disease / pancreatic disease – Medication
– Irritable bowel syndrome

28
Q

What are upper GI tract red flags? (10)

A
  • Dysphagia
  • Evidence of blood loss
  • Unexplained weight loss
  • Upper abdominal or epigastric mass
  • Unexplained back pain
  • Painless jaundice
  • Persistent vomiting
  • Unexplained iron deficiency anaemia
  • Unexplained worsening dyspepsia without other symptoms if >55 yrs old
  • New onset upper GI pain if >55yrs old OR if risk factor (e.g.+ve FH)
29
Q

What are lower GI tract red flags? (7)

A

• Bleeding:
– Repeated rectal bleeding without an obvious anal cause
– Any blood mixed with stool

• Bowel habit:
– Persistent change in bowel habit especially to looser stools (> 4 wks)

• Mass:
– Right-sided abdominal mass
– Palpable rectal mass

• Iron deficiency anaemia:
– Unexplained iron deficiency anaemia

• Other:
– Past history of lower GI cancer with any of symptoms above

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