General gastrointestinal Flashcards
Pain (Peptic ulcer)
SOCRATES
Site - epigastric Onset - acute or gradual Character - gnawing Radiation - into back Associated (can lead to GI haemorrhage, peritonitis etc) Timing - 30 mins - 3 hours Exacerbating - hunger, smoking, alcohol, NSAIDs Alleviating - food antacids vomiting Severity - mild to moderate
Pain (acute cholecystitis)
SOCRATES
Epigastric or right hyochondrial Constant, unpredictable Stabbing pain Radiates to right scapula/shoulder Associated - vomiting, fever, rigors 3-24 hours Food may make it worse Severe pain
Pain (Acute pancreatitis)
SOCRATES
Epigastric Sudden/gradual onset piercing/burning pain radiates to back Associated - vomiting nausea, abdominal distention 24+ hours eating makes it worse sitting up makes it better very severe pain
Abdominal distension
Usually due to adiposity
Intra abdominal disease suggested if they are otherwise getting thinner (subacute bowel obstruction, ascites, ovarian cyst. pregnancy, chronic constipation)
Nausea and vomiting
Frequency
Timing (time of day)
Taste, colour, smell, quantity
Haematemesis (fresh/coffee like)
GI causes - obstruction, gastritis, cholecystitis, pancreatitis, hepatitis
Other causes - neuro - motion sickness, migraine, meningitis, intracranial tumour
Severe pain - MI, renal colic
Systemic conditions - pregnancy, renal failure, diabetic ketoacidosis, hyperparathyroidism
Dysphagia
Continuous/intermittent? Duration Where does food get stuck Solids liquids or both Between meals? Acid reflux/dyspepsia? Nocturnal coughing? Ask about risk factors for oesophageal cancer - smoking, fat, no veg
Causes - painful lesions in moth/throat
Neurological
Neuromuscular (myasthenia gravis)
Obstruction post cricoid (tumours stricture etc)
Dyspepsia
Heartburn pain
Jaundice
Colour of urine/stools?
Hx of gallstones?
Pain? - radiating to back - pancreatic - worse lying down
Fever, rigors?
Itching?
SH- alcohol, drugs, travel - tattoos etc, sexual Hx
Altered bowel habit
Diarrhoea, constipation or both?
Frequency of stools?
Associated abdominal discomfort or urgency
Incontinence
Appearance - consistency, floats, slime, blood pus?
Associated vomiting?
Travel? Medications?
Rectal bleeding
Haemorrhoids - fresh red, painless
Carcinoma - mucus?
Inflammatory bowel disease - pus, mucus, unformed stool
Diverticula disease
Anal fissure - fresh red - severe pain on and after passages
Méléna - dark stool - upper GI bleed
Weight loss/appetite
How much weight, how quick
Associated with loss of appetite? - non GI causes (depression)
No change in intake - DM, hyperthyroidism, malabsorption
GI past history
Previous GI diagnoses
Previous GI surgery
Gynaecological problems (fistula etc)
History of jaundice, anaemia, DM
Drug history
NSAIDs
Iron
Opiates etc
Social history
Alcohol Smoking Occupation Diet Travel
Symptoms to ask about
Weight/appetite changes Swallowing problems Indigestion/heart burn Jaundice Abdominal pain Change in bowel habit - constipation/diarrhoea Stool consistency etc Incontinence
