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Zero to Finals > Common Abdominal Histories > Flashcards

Common Abdominal Histories Flashcards

1
Q

Examples of different presenting complaints a patient may have?

A
  1. abdominal pain
  2. change in bowel habit
  3. rectal bleeding
  4. haematemesis
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2
Q

A patient presents with abdominal pain, what other areas would you want to explore?

A
  1. general
  2. GI
  3. urological
  4. gynaecological if relevant
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3
Q

GI system review will involve checking for:

A
  • weight loss
  • appetite change
  • dysphagia
  • nausea
  • heart burn
  • indigestion
  • bowel habit change
  • blood / mucus in stool
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4
Q

general systems review would include querying about:

A
  • fevers

- sweats

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5
Q

urological systems review will mean asking about:

A
  1. storage
    - frequency
    - volume
    - urgency
    - nocturia
  2. infection
    - dysuria
    - haematuria
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6
Q

gynae systems review involves asking about:

A
  1. PV bleeding
    - menorrhagia
    - intermenstrual bleeding
    - post coital
    - post menopausal bleeding
  2. PV discharge
  3. Pain: pelvic / dysmenorrhoea / dyspareunia
  4. pregnant?
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7
Q

Abdominal pain

the following points to which differential:

  • younger patient
  • periumbilical pain
  • moves to RIF
  • anorexia
A

appendicitis

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8
Q

Abdominal pain

the following points to which differential:

  • intermittent RUQ
  • exacerbated by fatty food
A

gallstones

- biliary colic

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9
Q

Abdominal pain

the following points to which differential:

  • continuous RUQ pain
A

cholecystitis

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10
Q

Abdominal pain

the following points to which differential:

  • jaundice
  • RUQ pain
A

common bile duct stones

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11
Q

Abdominal pain

the following points to which differential:

  • jaundice
  • fevers / rigors
  • RUQ pain
A

cholangitis

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12
Q

Abdominal pain

the following points to which differential:

  • severe epigastric/ central pain
  • radiating to back
  • relieved by sitting forwards
  • vomiting
A

pancreatitis

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13
Q

Abdominal pain

the following points to which differential:

  • epigastric pain
  • related to meals
  • risk factors: e.g. NSAIDs, alcohol, spicy food
A

gastritis / peptic ulcer

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14
Q

Abdominal pain

the following points to which differential:

  • elderly
  • LIF pain
  • pyrexia
A

diverticulitis

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15
Q

Abdominal pain

the following points to which differential:

  • vomiting
  • abdo pain
  • no bowel motions
A

bowel obstruction

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16
Q

Abdominal pain

the following points to which differential:

  • spasms of loin to groin pain (excruciating)
  • nausea and vomiting
  • cannot lie still
A

renal colic

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17
Q

Abdominal pain

the following points to which differential:

  • increasing iliac fossa/ pelvic pain
  • 6 weeks pregnancy / not using contraception
  • may have spotting
A

ectopic pregnancy

18
Q

other differentials of abdominal pain to be aware of

A
  • ruptured AAA
  • gastroenteritis
  • volvulus
  • pyelonephritis
  • IBD
  • mesenteric ischaemia
  • pelvic inflammatory disease
  • endometriosis
  • MI, pneumonia, DKA
19
Q

what should you ask in a patient with a change in bowel habit:

A

Timing

  • when it started
  • onset
  • duration
  • progression
  • intermittent or continuous

Stool

  • how much, how often, consistency
  • colour and contents (mucus, blood, bile if vomiting)
20
Q

Change in bowel habit:

the following points to which differential:

  • elderly
  • blood in stool , melaena
  • weight loss
A

colon cancer

21
Q

Change in bowel habit:

the following points to which differential:

  • acute diarrhoea
  • nausea and vomiting
A

gastroenteritis

22
Q

Change in bowel habit:

the following points to which differential:

  • blood / mucus in stool
  • abdominal pain
A

inflammatory bowel disease

23
Q

Change in bowel habit:

the following points to which differential:

  • fluctuate between diarrhoea and constipation
  • associated with stress
  • anxious personality
A

irritable bowel syndrome

24
Q

Change in bowel habit:

the following points to which differential:

  • diarrhoea, steatorrhoea
  • anaemia symptoms
  • abdominal discomfort
A

coeliac disease

25
Q

Change in bowel habit:

the following points to which differential:

  • diarrhoea
  • heat intolerance
  • irritability / restlessness
  • tremor
  • oligomenorrhoea / amenorrhoea
A

thyrotoxicosis

26
Q

Change in bowel habit:

the following points to which differential:

  • constipation
  • cold intolerance
  • lethargy
  • menorrhagia
A

hypothyroidism

27
Q

other differentials for change in bowel habit?

A
  • bowel obstruction
  • diet, lifestyle changes
  • haemorrhoids, fissure
  • drugs (opiates, iron, antacid, abx)
  • diverticulitis
  • overflow constipation
  • lactose intoleranc e
  • chronic infection
28
Q

What else would you ask a patient presenting with rectal bleeding?

A
  1. timing
  2. blood: altered, fresh, melaena
  3. when does it occur
  4. stool: mucus, consistency, how much, how often
29
Q

Rectal Bleeding

the following points to which differential:

  • bleeding on defecation
  • bright red on tissue paper
  • intense anal pain
  • constipation history
A

anal fissure

30
Q

Rectal bleeding

the following points to which differential:

  • bleeding on defecation
  • bright red on tissue paper
  • constipation history
A

haemorrhoids

31
Q

Rectal bleeding

the following points to which differential:

  • sudden painless rectal bleeding
  • elderly
A

diverticular haemorrhage

32
Q

Rectal bleeding

the following points to which differential:

  • alternating bowel habit
  • weight loss
  • urgency
  • tenesmus
A

distal polyp / cancer

33
Q

Rectal bleeding

the following points to which differential:

  • blood mixed with stool
  • mucus
  • diarrhoea
  • abdominal pain
A

inflammatory bowel disease

34
Q

Rectal bleeding

the following points to which differential:

  • acute diarrhoea and vomiting
  • history of suspicious food intake
A

haemorrhagic infective gastroenteritis

35
Q

Rectal bleeding

the following points to which differential:

  • weight loss
  • anaemia symptoms
A

proximal polyp, cancer

36
Q

Rectal bleeding

the following points to which differential:

  • gastritis symptoms
  • risk factors e.g. NSAIDs, alcohol, spicy food
A

haemorrhagic peptic ulcer / gastritis

37
Q

Rectal bleeding

the following points to which differential:

  • hx liver disease
  • hx alcoholism
  • may be encephalopathy or alcohol withdrawal
  • haematemesis
A

oesophageal varices

38
Q

Haematemesis

the following points to which differential:

  • previous gastritis symptoms
A

peptic ulcer haemorrhage

39
Q

Haematemesis

the following points to which differential:

  • hx liver disease, alcoholism
  • may be encephalopathy or alcohol withdrawal
A

oesophageal varices

40
Q

Haematemesis

the following points to which differential:

  • multiple vomits before haematemesis onset
  • commonly after binge drinking
A

mallory-weiss tear

41
Q

Haematemesis

the following points to which differential:

  • previous gastritis symptoms
  • risk factors e.g. NSAIDs, alcohol, spicy food
A

haemorrhagic gastrits

oesophagitis

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