GI and GU history taking Flashcards
how do you ask about pain
scale on 1- 10 stops you sleeping writhing ask patient to show you and watch hands socrates does it stop you doing anything sharp/dull/throbbing etc
what is renal colic
pain from kidney stones
pain in loin and groin
what could shoulder tip pain indicate
irritation of the diaphragm
gallstones
what could pain radiating to the back indicate
pancreatitis
what does Socrates stand for
Site Onset Character Radiation Associations Time Exacerbating/Relieving factors Severity
what associated symptoms might be present
nausea/ vomiting diarrhea vaginal bleeding and discharge sweating/ fever urinary symptoms weight loss/gain
what questions can you ask about diet
has your appetite changed are your clothes looser? have you been trying to lose weight have you lost weight? do you still enjoy food
what could be possible causes of weight loss
malignancy malabsorption metabolic diseases psychiatric malnutrition
what could cause weight gain
fluid gain eg due to heart failure
hypothyroidism
depression
what could cause fluid gain
heart failure
nephrotic syndrome
liver disease
what are the symptoms of dyspepsia
heart burn, wind, belching, vomiting, discomfort, fullness, bloating
what is globus sensation
the feeling of something in your throat
what are the neuro causes of dysphagia
CVA
bulbar or psuedobulbar palsy
what are the neuromuscular causes of dysphagia
Achalasia
Pharyngeal pouch
Myasthenia Gravis
Diffuse oesophageal spasm
what are the mechanical causes of dysphagia
Oesophageal carcinoma Peptic oesophagitis Benign stricture Extrinsic compression (e.g. lung tumour, lymph nodes, goitre)
what are the oral causes of dysphagia
Painful mouth ulcers
Tonsillitis / pharyngitis / glandular fever
what questions can you ask about dysphagia
solids/ liquids where is the obstruction intermittent? associated symptoms pain regurgitation
what questions can you ask about nausea and vomiting
pain, diarrhea, constipation changes to medication pregnancy or possible pregnancy frequency and duration vomitus- food/ blood/ bile
what could cause haematemesis
– Gastric or duodenal ulcer gastric erosions varices Mallory-Weiss syndrome Reflux oesophagitis gastric carcinoma
what is the most common cause of severe and life threatening GI bleeding
peptic ulcers
what does melaena indicate
black tarry stools
bleeding in the oesophagus, duodenum or stomach but may be further down
most commonly caused by chronic peptic ulceration
what questions can you ask about blood in the stool
is it on the surface or mixed in?
duration and frequency
associated symptoms
what symptoms may be associated with blood in stool
diarrhoea, constipation, abdo pain, change in bowel habit, weight loss, rectal/ anal pain
what may cause blood in stools
Haemorrhoids / anal fissure / diverticular disease / large bowel
polyps or carcinoma / inflammatory bowel disease
what is pre hepatic jaundice
a condition or infection speeds up the breakdown of red blood cells. This causes bilirubin levels in the blood to increase
what is hepatic jaundice
a problem in the liver affects its ability to process bilirubin
what is post hepatic jaundice
the bile duct system is damaged, inflamed or obstructed, which results in the gallbladder being unable to move bile into the digestive system.
what questions can you ask about bowel habit
Duration
– Colour of stool – mucous / fresh or altered blood
– Constipation / diarrhoea, or mixture of both
– Associated symptoms e.g. pain / nausea or vomiting / weight loss /
appetite / tenesmus (feeling of not fully emptying bowels)
– Changes in diet or medication / other illnesses
what topics should be covered in a GI systems inquiry
abdo pain anorexia weight loss dyspepsia dysphagia nausea and emesis bleeding jaundice bowel habit
what topics should be covered in a GU systems inquiry
urinary frequency dysuria nocturia incontinence hesitancy urgency flow haematuria ( may macro/microscopic) pain frequency
what GU questions can women be asked
vaginal bleeding discharge menstrual history obstetric history (pregnancies and births) sexually active contraception last menstrual period ectopic pregnancy STI surgeries pelvic pain
what types of malabsorption might cause weight loss
pancreatitis
coeliac disease
crohn’s disease
what types of metabolic disease might cause weight loss
diabetes
hyperthyroidism
renal disease
chronic infection
what questions should be asked if a patient presents with jaundice
duration pain weight loss fevers colour of stool and urine travel shellfish consumption blood transfusion alcohol consumption medication IV drug use unprotected sex
what does painless jaundice indicate
carcinoma of head of pancreas
what does tenesmus mean
the feeling of not fully emptying one’s bowels
what can cause constipation
diet dehydration anal fissure or similar immobility medication e.g. opiates hypothyroidism colonic/ rectal carcinoma neuromuscular e.g. Parkinson's or MS hypercalcaemia which may be related to malignancy
what may cause diarrhoea
diet stress infection inflammation endocrine eg. hyperthyroidism malabsorption e.g. coeliac/ pancreatic disease medication chronic overflow
what are some upper GI red flags
evidence of blood loss weight loss pain or mass painless jaundice persistent vomiting iron deficiency anaemia worsening dyspepsia
what are some lower GI red flags
- > = 40 yrs old with rectal bleeding and change of bowel habit
- > =60 yrs old with rectal bleeding for 6 weeks or more without a change in bowel habit and no anal symptoms
- > =60 yrs old with a change in bowel habit to looser stools and / or more frequent stool for 6 weeks or more without rectal bleeding
- Of any age with right lower abdominal mass consistent with involvement of large bowel
- Of any age with palpable rectal mass
- Unexplained iron deficiency anaemia
what symptoms are associated with a lower UTI aka cystitis or bladder infection
dysuria frequency urgency suprapubic discomfort haematuria
what symptoms are associated with an upper UTI aka pyelonephritis or kidney infection
loin pain fevers rigors flank tenderness urinary frequency dysuria haematuria
what are the symptoms of prostatism
irritative- urgency, dysuria, frequency, nocturia
obstructive- reduced force of urine flow, hesitancy, interruption of stream
perineal pain
what may cause haematuria
uti, calculi, carcinoma of bladder, kidney or prostate, glomerulonephritis, BPH,
bleeding disorders or anticoagulants
what are GU red flags
- Any age with painless macroscopic haematuria
- > =40 with recurrent or persistent UTI associated with haematuria
- > =50 with unexplained microscopic haematuria
- Abdominal mass thought to be from urinary tract
- Hard irregular prostate
- Normal prostate, but rising / raised age specific PSA with or without lower urinary tract symptoms
- Symptoms and high PSA levels
what is mallory weiss syndrome
gastro-esophageal laceration syndrome caused by vomiting and causes haematemesis
