Gastrointestinal History Taking Flashcards
Briefly outline a history taking structure
Introduce - hands, self, patient, explain
Presenting complaint - open questions
History of complaint - e.g. SOCRATES
GI symptom review & Red flags
ICE
Past medical history & Family history
Drug history, OTC & Allergies
Social history - job, home, habits, travel
Summary, clarify, safety net, thanks
Name GI symptoms & Red flags 🚩
Nausea, vomiting & (haematemesis 🚩)
Dysphagia, appetite & (weight loss 🚩)
Heartburn & reflux
Change in bowel habit, Abdominal pain
Constipation, Diarrhoea & Steatorrhea
(Rectal bleeding), (blood in stool 🚩) & (Malena 🚩)
Tenesmus, urgency & Incontinence
What does SOCRATES stand for
Site, Onset, Character, Radiation, Associated symptoms, Timing, Exacerbating factors, Severity
If a patient came in with vomiting or nausea what would you want to ask about
Nausea - Timing (duration & frequency), Exacerbating factors & Associated symptoms (TEA) ☕️
Vomiting - (TEA) ☕️ & Appearance 👀(character, quantity, contents)
What would you want to ask about if someone came in with constipation or diarrhoea
Constipation - TEA ☕️ & Appearance 👀(colour)
Diarrhoea - TEA ☕️ & Appearance 👀(colour, texture, blood or mucous)
What is an important differential question to ask if someone presents with dysphagia?
Is it painless or painful?
How would you describe a) melena b) steatorrhea
a) black, tarry stool, foul smelling
b) bulky, greasy stool
What symptoms would be associated with jaundice
Yellow skin and eyes, itchy skin, dark urine, pale stools
Jaundice differentials
hepatitis, liver cirrhosis and biliary obstruction (e.g. gallstone, pancreatic cancer)
Aphthous ulcers differentials
- stress or mechanical trauma
- iron, B12 and folate deficiency
- Crohn’s disease
Vomiting differentials
- infections (e.g. gastroenteritis)
- pyloric stenosis (projectile non-bilious vomiting)
- bowel obstruction (typically bilious),
- gastroparesis (e.g. secondary to diabetes)
- pharyngeal pouch and oesophageal stricture (vomit containing undigested food)
Heamatemesis differentials & the colour of each
Mallory-Weiss tear - fresh red
Oesophageal variceal rupture - fresh red
Gastric or duodenal ulcer -coffee ground
How do patients tend to describe GORD
Patients typically describe epigastric discomfort which is burning in nature
Painless dysphagia & painful dysphagia (odynophagia) differentials
Painless dysphagia - oesophageal cancer
Painful dysphagia - oesophageal obstruction (e.g. stricture) or infection (e.g. oesophageal candidiasis)
Abdominal distension differentials
ascites, constipation, bowel obstruction, organomegaly and malignancy
Constipation differentials
- dehydration
- reduced bowel motility (e.g. autonomic neuropathy)
- medications (e.g. opiates, ondansetron, iron supplements)
Diarrhoea differentials
- infection (e.g. C.difficle),
- irritable bowel syndrome,
- inflammatory bowel disease,
- medications (e.g. laxatives),
- malignancy
Steatorrhea differentials
- pancreatitis,
- pancreatic cancer,
- biliary obstruction,
- coeliac disease,
- medications (e.g. Orlistat)
What is melena and what causes it?
digested blood in stool secondary to upper gastrointestinal bleeding (e.g. peptic ulcer)
Lower GI bleed (fresh blood in stool/rectum) differentials
haemorrhoids, anal fissures and lower gastrointestinal malignancy
State some systemic symptoms and what GI conditions they may be associated with
- Anorexia
- Weight loss (e.g. malabsorption, malignancy)
- Nausea
- Fatigue
- Fever (e.g. intrabdominal infection)
- Pruritis (e.g. cholestasis)
- Confusion (e.g. hepatic encephalopathy)
Abdominal pain differentials depending on their location/ quadrant
- Right iliac fossa pain (appendicitis, Crohn’s disease, ectopic pregnancy)
- Left iliac fossa (diverticulitis, ectopic pregnancy)
- Epigastric pain (oesophagitis and gastritis)
- Right upper quadrant pain (cholecystitis and hepatitis)
- Flank pain (renal colic and pyelonephritis)
- Suprapubic pain (urinary tract infection)
Travel history is important with GI presentations. What might you want to ask about?
Area of travel, diet, insect bites, contaminated water
What are 3 important OTC drugs to ask about with GI presentations
- Aspirin (may worsen gastrointestinal bleeding)
- NSAIDs (may cause gastric/duodenal ulceration)
- St John’s Wort (an enzyme inducer which may alter the clearance of prescribed medications)
