GI

Question 1

13 symptoms to ask?

Answer 1

Pain, weight loss, appetite, difficulty swallowing, dyspepsia, nausea/vomiting, abdominal distension, previous gallstones/pancreatitis, jaundice, altered bowel habit/diarrhoea/constipation, mucus/slime/blood PR, incontinence

Question 2

SOCRATES peptic ulcer?

Answer 2

S - epigastric
O - acute/gradual (remission for weeks/months)
C - gnawing
R - into back
A - GI haemorrhage, peritonitis if perf
T - 0.5 to 3 hours
E - irregular meals (hunger), NSAID/asprin, smoking, alcohol
A - food, antacids, vomiting
S - mild to moderate

Question 3

SOCRATES acute cholecystitis?

Answer 3

S - epigastric/right hypochondiacal 
O - constant, unpredictable freq/periodicity
C - stabbing/piercing
R - right scapula/tip of right shoulder
A - vomiting, fevers, rigors
T - 3-24 hours
E - poss. food
S - severe

Question 4

SOCRATES acute pancreatitis?

Answer 4

S - epigastric
O - sudden or gradual
C - piercing, stabbing, burning
R - into back, may develop generalised peritonitis
A - nausea/vomiting, abd. distension, shock
T - >24 hours
E - eating
A - sitting upright
S - very severe

Question 5

5 non-GI causes vomiting?

Answer 5

N/S (motion sickness, labyrinthine disorders, meningitis, intracranial tumour, migraine)
Severe pain (renal collic, MI)
Systemic (pregnancy, DKA, renal failure, hyperparathyroidism)
Drugs (central action/gastric irritation)

Question 6

5 GI causes vomiting?

Answer 6

Gastric outlet obstruction, acute gastritis, acute pancreatitis, acute cholecystitis, hepatitis

Question 7

7 vomit questions?

Answer 7

Frequency, time of day, quantity, colour, smell, taste, blood (fresh or ground coffee)

Question 8

5 causes dysphagia?

Answer 8

Painful lesion mouth/throat, neuro (eg pseudobulbar palsy), MSK (eg myaesthenia gravis), obstruction in post-cricoid area (pharyngeal pouch/tumour/stricture), obstruction of lower oesophagus (tumour/achalasia or the cardia/stricture)

Question 9

8 questions dysphagia?

Answer 9

Continuous/intermittent, solids/liquids, how long does it last, where does food stick, between meals?, acid reflux/dyspepsia, nocturnal coughing/dypnoea, oesophageal cancer RF (smoking, alcohol, obesity, diet low in fruit/veg)

Question 10

6 questions jaundice?

Answer 10

Stools pale/urine dark, Hx gallstones, pain (Ca pancreas felt in back and worse on recumbency), itching, fevers/rigors, social history (alcohol, drugs, foreign travel, infusions/tattoos abroad), unprotected sex

Question 11

8 altered bowel habit questions?

Answer 11

Diarrhoea/constipation/both, frequency, ass. discomfort/urgency, incontinence, appearance stool (formed/unformed, floating in pan, blood/slime/pus), ass. vomiting, foreign travel, medications (inc overcounter)

Question 12

6 causes rectal bleeding?

Answer 12

Haemorrhoids, carcinoma colon/rectum, melena (may contain clots, patient poss in shock), IBD, diverticular disease, anal fissure (severe pain)

Question 13

5 non-adipose causes abdominal distension ?

Answer 13

Subacute bowel obstruction, pregnancy, chronic constipation, ovarian cyst, ascites

Question 14

4 closing GI Hx questions?

Answer 14

Previous GI problems/diagnoses/treatment, previous GI/abd surgery, gynae problems, hx jaundice/anaemia/diabetes

Question 15

7 drugs with GI side-effects?

Answer 15

Iron tablets, opiates, NSAIDs, antibiotics, SSRI, anticoagulants

Question 16

5 social history questions?

Answer 16

Smoking, alcohol, occupation, diet, recent foreign travel

Question 17

5 diseases where family history relevant?

Answer 17

Some colon carcinomas, crohn’s, UC, some malabsorption conditions, Gilberts (inherited unconjugated hyperbilirubinaemia)