3. History Taking- Abdomen and GU Flashcards
What are the systems enquiry questions for the HPC GI?
- Abdominal pain
- Anorexia and weight change
- Dyspepsia / Indigestion
- Dysphagia
- Nausea and vomiting
- GI tract bleeding
- Jaundice
- Change in bowel habit – constipation / diarrhoea
Always remember RED FLAGS
What are the systems enquiry questions for the HPC of GU?
- Dysuria – pain / burning passing urine
- Urinary frequency – need to go more often
- Urgency – need to go NOW
- Hesitancy – want to go, but it won’t start
- Nocturia- passing urine at night
- Urinary flow - strength of urinary stream (mainly men)
- Incontinence – stress or urge or mixed
- Haematuria – blood in urine. Can be microscopic or macroscopic
- Loin pain - Pain at the side of the back , below the ribs
What are the questions to ask regarding pain?
Socrates
- Site
- Onset
- Character
- Radiation
- Associated symptoms
- Timing
- Exacerbators/relievers 8. Severity
What are the names of the 9 regions for identifying pain?
Right hypochondrium Epigastric region L hypochondrium R flask Umbilical region L flank R iliac fossa Hypogastric/ suprapubic region L iliac fossa
What are the names of the 4 quadrants?
Right upper quadrant
Left upper quadrant
Right lower quadrant
Left lower quadrant
What condition do the following pain radiations suggest:
– Radiation to the back
– Shoulder tip
– Radiation from loin to groin
– Radiation to the back – pancreatitis
– Shoulder tip- diaphragmatic irritation
– Radiation from loin to groin- renal colic (kidney stone)
What re 5 associated symptoms to GI pain?
– Sweating / Fevers – Vomiting /nausea – Diarrhoea – Urinary symptoms – Vaginal bleeding / discharge
WEIGHT LOSS **
Name 5 common exacerbates and receivers for GI pain?
Common exacerbating factors: – Eating/noteating – Movement/ lack off – Position – Exercise(thinkcardiacdisease) – Urination/menstruation
Common relieving factors: – Eating/noteating – Vomiting/openingbowels – Movement/lackofmovement – Position
4 causes of weight gain
– Fluid gain e.g. cardiac failure, liver disease, nephrotic syndrome – Hypothyroidism – Depression – Increased energy input/ output ratio
5 causes for unexplained weight loss
– Malignancy
– Malabsorption e.g. chronic pancreatitis / coeliac disease / Crohn’s disease
– Metabolic diseases e.g. diabetes, hyperthyroidism, renal disease, chronic infection (TB/ HIV)
– Psychiatric causes e.g. depression / dementia / anorexia nervosa
– Malnutrition
Dyspepsia?
Indigestion
Symptoms of dyspepsia?
Heartburn, acidity, pain, discomfort, nausea, wind, fullness or belching
What is dyspahgia?
Sensation of obstruction during passage of liquid or solid
food through pharynx or oesophagus
Can be confused with globus
Causes of dysphagia: Oral (2) Neurological (2) Neuromuscular (4) Mechanical (5)
Oral:
Painful mouth ulcers
Tonsillitis / pharyngitis / glandular fever
Neurological:
CVA
Bulbar or pseudobulbar palsy
Neuromuscular:
Achalasia
Pharyngeal pouch Myasthenia Gravis
Diffuse oesophageal spasm
Mechanical: Oesophageal carcinoma Peptic oesophagitis Benign stricture Extrinsic compression (e.g. lung tumour, lymph nodes, goitre)
What is haematemesis?
Causes?
Vomiting blood - fresh red or “coffee-ground)
Causes: Gastric/duodenal ulcer, gastric erosions, varices
Sign and cause for upper GI bleeding?
Malaena: Passage of black tarry stools.
Usually secondary to bleed in oesophagus, stomach or duodenum. Caused by peptide ulceration
Sign and cause of lower GI bleeding?
Questions to ask?
Associated symptoms?
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
Jaundice: What is it? Causes? Questions to ask? Painless jaundice suggests..
Jaundice: Yellow discolouration of sclerae/skin
Causes: Pre-hepatic/ hepatic/ post-hepatic
Questions to ask:
- Duration?
- Associated symptoms?
- Colour of stool and urine
- Travel
- Consumption of shellfish
- Blood transfusion
- Alcohol consumption
- Changes in medications
- Unprotected sex
Painless jaundice suggests carcinoma of head of pancreas
Common causes of constipation?
Diet/dehydration Painful anal conditions Immobility Medication e.g. opiates Hypothyroidism Colonic / rectal carcinoma Neuromuscular e.g. spinal cord disease / Parkinson's disease Hypercalcaemia IBS
Common causes of diarrhoea
– 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
10 Upper GI red flags
- 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)
7 lower GI tract red flags?
Repeated rectal bleeding Blood mixed with stool Persistent change in bowel habit Right sided abdominal mass Palpable rectal mass Unexplained iron deficiency anaemia Past history of lower GI cancer plus any of above
What is the difference in the presentation of a lower UTI and and upper?
Lower UTI = Cystitis (bladder inflammation)
Symptoms: Dysuria, frequent urination, urgent, suprapubic discomfort, possible haematuria
Upper UTI = Pyelonephritis (kidney inflammation)
Symptoms: Loin pain, fevers, riggers, flank tenderness, urinary frequency, dysuria, possible haematuria
What is prostatism?
Symptoms of prostate enlargement:
- Irritative: Urgency/dysuria/ frequency/ nocturia
- Obstructive: Reduced force of stream / hesitancy
- Prostatitis can cause perineal pain
Causes for loin pain?
Pyelonephritis Renal calculi (loin to groin) Hydronephrosis Renal tumour Renal abscess Referred pain from back
Causes of haematuria
UTI Urinary tract calculi Bladder carcinoma Glomerulonephritis Renal carcinoma Benign prostatic hypertrophy Prostatic carcinoma
Which type of haematuria much be investigated further
Macroscopic
Persistent microscopic
What are the GU red flags
- Any age with painless macroscopic haematuria
- Haematuria and symptoms of UTI but sterile urine
- Testicular swelling
- Abdominal mass from urinary/genital tract
- Hard irregular prostate
- Normal prostate, but rising / raised age specific PSA (prostate specific antigen) with or without lower urinary tract symptoms
- Symptoms and high PSA levels
- Postmenopausal bleeding
- Persistent intermenstrual bleeding
- Palpable pelvic mass/cervical lesion/vulval mass
