gastro hx

Question 1

questions that needs to be included in general gastro hx?

Answer 1

1) heartburn/dyspepsia
2) dysphagia
3) N+V +/- haematemesis
4) abdo pain
5) diarrhoea & constipation
6) change in bowel habits
7) PR bleed
8) wight loss & loss of appetite
9) jaundice, yellow sclerae, pale stoole & dark urine
10) reoccurring mouth ulcers
11) recent travel hx

Question 2

what should be included in abdo pain hx

Answer 2

SOCRATES
- if intermittent - can be bowel due to parasitic movement

Ask if related to food - GORD

N+V 
diarrhea 
Abdo distension 
fever 
jaundice - pale stool, dark urine, yellow sclera 
recent traveling

weight loss, change in bowel habits, night sweat

UTI symptoms - frequency, dysuria, haematuria

if child bearing age - ask about possibility of pregnancy

Question 3

what are the PMH that should be included in a gastro hx

Answer 3

IDB? IBD?
peptic ulcer?
abdo surgery?

Question 4

FHx that should be included in gastro hx

Answer 4

colon cancer
IBD
coeliac disease

Question 5

SHx that should be included in gastro hx

Answer 5

stress? 
work 
smoker? 
alcohol? 
who is at home with you?

Question 6

what are the characteristics of acute pancreatitis

Answer 6

central abdo pain which radiates through to the back

pain worsen when sitting forward

excessive alcohol intake

Question 7

where would abdo pain radiate to if it is GORD?

Answer 7

to neck

Question 8

what can shoulder tips means in the contest of abdo pain

Answer 8

rupture ectopic pregnancy
diaphragmatic irritation
ca for liver

Question 9

what should be included in the dysphagia history?

Answer 9

1) how long have they have difficulty swallowing
2) getting worse or better
3) is swallowing painful?
4) is food stuck in the throat?
5) swallowing difficult the same for solid and fluid?
6) weight loss and loss of appetite?
7) does difficulty eases after a few seconds?
8) fluid ever regurgitates into the throat/ causes pt to choke?
9) any heartburn hx?
10) noticed any lump in the neck? - when, how big
11) noticed any SOB, voice changes (coarse)?

Question 10

what can progressive swallowing difficulty mean?

Answer 10

carcinoma or stricture in the esophagus

Question 11

what can intermittent swallowing difficulty mean?

Answer 11

can mean achalasia

Question 12

what can painful swallowing mean?

Answer 12

infection - candida, HSV

Question 13

what can dysphagia with solid only mean?

Answer 13

Ca / stricutre

Question 14

what can dysphagia with solid and fluid mean?

Answer 14

achalasia

Question 15

what does swallowing difficulty eases after a few seconds mean?

Answer 15

oesophageal spams?

Question 16

what does fluid ever regurgitates into the throat/ causes pt to choke mean?

Answer 16

neuro conditions

Question 17

what does dyspepsia mean?

Answer 17

indigestion

Question 18

what should be included in dyspepsia hx?

Answer 18

1) ask pt to describe what they feel?
2) reflux symptoms worsened by food, alcohol, chocolate, caffeine, and fatty meals?
3) if bending, lying forward or stopping worsen symptoms
4) ever got a sour/bitter taste fluid backing up in the mouth
5) ever vomiting
6) any weight loss and loss of appetite
7) any blood in the stool
8) feeling unusually full after small amounts?
9) anything that makes indigestion better or worse?
10) ever bloated after meals?

Question 19

why do you ask about vomiting in dyspepsia hx?

Answer 19

because pt could have vomited blood up due to peptic ulcer erosion

Question 20

what can feeling unusually full after meal mean?

Answer 20

gastric cancer

Question 21

what should be included in vomiting hx?

Answer 21

1) how often
2) how much
3) what came up
4) sudden onset or longstanding
5) vomiting at a particular time of day?
6) projectile
7) any systemic symptoms - eg fever, night sweats
8) related to abdo pain?
9) doggy food/other family member affected?
10) change in bowel habit?
11) early satiety
12) any possibility of pregnancy
13) ask specifically about alcohol consumption

Question 22

what should be included in jaundice hx?

Answer 22

1) when did pt first noticed yellowing of eye/skin - is it progressive or fluctuating?
2) pale stool/dark urine
3) any abdo pain
4) weight loss
5) itchy skin?
6) any vomiting
7) any bruise/bleed easily
8) how much alcohol did they drink?
9) recent traveling abroad
10) any recent surgery
11) any blood transfusion ever
12) illicit drugs?
13) homosexuality

Question 23

what should be included in diarrhea hx?

Answer 23

1) how often currently and what is the normal amount
2) when did diarrhea first occur
3) any relationship to food
4) what colour is the motion
5) any mucus and blood?
6) if stool floats/difficult to flush away?
7) abdo pain? if so does passing flatus/stool relieves the pain
8) weight loss and loss of appetite
9) any vomiting
10) any recent travel/any change in diet
11) abdo distension/bloating
12) any thyroid conditions
13) every incontinence
14) any meds?
15) any recent SOB/tiredness
16) any FHx of colorectal Ca

Question 24

what does acute diarrhea mean?

Answer 24

infective in nature

Question 25

what does chronic diarrhea mean?

Answer 25

IBD/IBS/metabolic/endocrine

Question 26

what can mucus and blood in stool mean?

Answer 26

rectal ca / fistula

Question 27

what does relief from passing stool mean?

Answer 27

could be diverticulitis / IBS

Question 28

what does intermittent abdo distension + diarrhea mean?

Answer 28

IBS

Question 29

why do we ask about thyroid hx in diarrhoea hx?

Answer 29

because diarrhea is a symptom of thyrotoxicosis

Question 30

what should be included in constipation hx?

Answer 30

1) how often they pass motions and what is their normal
2) when did constipation first start
3) what colour the motion are
4) any abdo pain, if so, does passing flatus/stool help it?
5) pain on defecation?
6) straining/feeling of incomplete emptying
7) weight loss or loss of appetite
8) ever incontinence
9) vomiting?
10) any meds esp opiate
11) any recent SOB/tiredness
12) any Fhx

Question 31

what should be included in PR bleeding hx?

Answer 31

1) when did you first noticed blood in the stool?
2) what colour was the blood - frank/dark?
3) if blood was mixed in with the stool or outside of stool or in the toilet bowl or on the toilet paper
4) change in bowel habit?
5) any mucous or or slime wit the blood
6) abdo pain?
7) defecation painful?
8) weight loss and loss of appetite?
9) ever noticed a feeling of something coming down or dragging?
10) passing urine normally?
11) any anticoag meds
12) any SOB or tiredness
13) Fhx of colorectal cancer?