Gastrointestinal history and examination Flashcards
Gastrointestinal history: presenting symptoms
Abdominal pain. Distension. Nausea, vomiting, haematemesis. Dysphagia. Indigestion/dyspepsia/reflux. Recent change in bowel habit. Diarrhoea, constipation. Rectal bleeding or melaena. Appetite, weight change. Jaundice.
Gastrointestinal history: What direct questions should you ask someone presenting with abdominal pain?
SOCRATES.
Gastrointestinal history: What direct questions should you ask someone presenting with nausea/vomiting?
Timing? Relation to meals? Amount? Content? e.g. liquid, solid, bile, blood. Frequency?
Gastrointestinal history: What direct questions should you ask someone presenting with haematemesis?
Timing? Relation to meals? Amount? Frequency? Fresh (bright red)/dark/coffee grounds? Consider neoplasia- weight loss? dysphagia? pain? melaena? NSAIDs/warfarin? Surgery? Smoking?
Gastrointestinal history: What direct questions should you ask someone presenting with dysphagia?
Level? Onset? Intermittent? Progressive? Painful swallow (odynophagia)?
Gastrointestinal history: What direct questions should you ask someone presenting with indigestion/dyspepsia/reflux?
Timing?
Relation to meals?
Gastrointestinal history: What direct questions should you ask someone presenting with recent change in bowel habit?
Consider neoplasia- weight loss? dysphagia? pain? melaena?
Gastrointestinal history: What direct questions should you ask someone presenting with rectal bleeding or melaena?
Pain on defaecation?
Mucus?
Fresh/dark/black?
Mixed with stool/on surface/on paper/in the pan?
Gastrointestinal history: What direct questions should you ask someone presenting with appetite/weight change?
Intentional?
Quantify.
Dysphagia?
Pain?
Gastrointestinal history: What direct questions should you ask someone presenting with jaundice?
Pruritic?
Dark urine?
Pale stools?
Gastrointestinal history: past medical history
Peptic ulcer disease. Carcinoma. Jaundice. Hepatitis. Blood transfusions. Tattoos. Previous operations. Last menstrual period (LMP). Dietary changes.
Gastrointestinal history: drug history
Steroids.
NSAIDs.
Antibiotics.
Anticoagulants, e.g. clopidogrel with SSRI.
Gastrointestinal history: family history
IBS. IBD. PUD. Polyps. Cancer. Jaundice.
Gastrointestinal history: social history
Smoking. Alcohol (quantify units/week). Recreational drug use. Travel history. Tropical illnesses. Contact with jaundiced persons. Occupational exposures. Sexual history. Blood transfusions. Surgery overseas.
Gastrointestinal history: causes of vomiting, GI
Gastroenteritis. Peptic ulceration. Pyloric stenosis. Intestinal obstruction. Paralytic ileus. Acute cholecystitis. Acute pancreatitis.
Gastrointestinal history: causes of vomiting, CNS
Meningitis/encephalitis. Migraine. Raised intracranial pressure. Brainstem lesions. Motion sickness. Meniere's disease. Labyrinthitis.
Gastrointestinal history: causes of vomiting, metabolic/endocrine
Uraemia. Hypercalcaemia. Hyponatraemia. Pregnancy. Diabetic ketoacidosis. Addison's disease.
Gastrointestinal history: causes of vomiting, drugs
Antibiotics. Opiates. Cytotoxics. Digoxin. Alcohol.
Gastrointestinal history: causes of vomiting, psychiatric
Self-induced.
Psychogenic.
Bulimia nervosa.
Gastrointestinal history: causes of vomiting, others
Myocardial infarction.
Autonomic neuropathy.
Sepsis (UTI, meningitis).
Gastrointestinal history: causes of epigastric pain
Pancreatitis. Gastritis/duodenitis. Peptic ulcer. Gallbladder disease. Aortic aneurysm. Referred pain from MI or pleural pathology.