GI histories Flashcards
What PCs could be GI related?
Pain
Abdominal distension
Nausea and vomiting
Dysphagia (difficulty swallowing)
Dyspepsia (indigestion / heartburn), hiatus hernia and peptic ulceration
Altered bowel habit, diarrhoea, constipation or alternating diarrhoea and constipation
Blood loss (haematemesis or rectal bleeding)
Mucus or slime per rectum
Appetite
Weight change
Continence
Give the classic SOCRATES for a Peptic ulcer
Site: Epigastric
Onset: Acute or gradual. Remissions for weeks or
months.
Character: Gnawing
Radiation: Into the back
Asso sx: Can lead to GI haemorrhage, peritonitis if
perforates
Timing: Lasts 0.5 – 3 hours.
E / R factors: (E) Irregular meals (hunger), smoking, alcohol,
aspirin and NSAIDs
(R) Food, antacids, vomiting
Severity: Mild to moderate
Give the classic SOCRATES for ACUTE CHLOECYSTITIS
Site: Epigastric or right hypochondriacal
Onset: Constant.
Unpredictable frequency or periodicity.
Character: Stabbing, piercing
Radiation: Right scapula or tip of right shoulder
Asso sx: Vomiting, fever, rigors
Timing: 3 – 24 hours
E/R factors: (E) Sometimes food.
(R) Pain relief by medication?
Severity: Severe
Give the classic SOCRATES for ACUTE PANCREATITIS
Site: Epigastric
Onset: Sudden or gradual
Character: Piercing, stabbing, burning
Radiation: Into the back.
May develop generalised peritonitis with
widespread pain.
Asso sx: Nausea, vomiting, abdominal distension,
shock
Timing: Lasts more than 24 hours.
E / R factors: (E) Eating
(R) Sitting upright
Severity: Very severe
What GI disorders can present with VOMITING?
gastric outlet obstruction,
acute gastritis,
acute cholecystitis,
acute pancreatitis,
hepatitis
BO
What questions should you ask about VOMITING?
How frequent is the vomiting?
What time of day does it occur?
Taste, colour, smell and quantity?
Is there any blood in the vomit (haematemesis)?
Is it fresh blood altered blood (like coffee grounds)?
What can cause DYSPHAGIA?
Painful lesion in mouth or throat
Neurological disorder -> pseudobulbar palsy
Neuromuscular disorder -> myasthenia gravis
Obstruction in the post-cricoid area
————–> pharyngeal pouch
tumour
stricture
Obstruction at the lower end of the oesophagus
————–> tumour
achalasia of the cardia
stricture
What questions should you ask about DYSPHAGIA?
Is it continuous or intermittent?
How long does it last for?
Where does the food stick?
Is it solids, liquids or both?
Does it occur between meals (may suggest globus hystericus, a psychogenic condition)?
Do you suffer from acid reflux or dyspepsia?
Nocturnal coughing or dyspnoea (2° to regurgitation and aspiration)?
Risk factors for oesophageal carcinoma:
smoking
alcohol
obesity
diet lacking in fruit and vegetables
What questions do you ask about JAUNDICE?
Colour of urine and stools (differentiate haemolytic from obstructive jaundice)
History of gallstones?
Pain (pain of Ca pancreas is traditionally felt in the back and made worse on recumbency)?
Painless jaundice -> ? Cholangiocarcinoma
Fever and rigors?
Itching?
Social history
-> Alcohol
-> Drugs
-> Foreign travel, including transfusions and tattooing
abroad
-> Unprotected sex
What do you ask about ALTERED BOWEL HABIT?
How has the habit altered? Diarrhoea, constipation or both?
Frequency of stools?
Any associated abdominal discomfort or urgency?
Incontinence?
Appearance of stool?
Consistency (formed or unformed)?
Does it float in the pan?
Associated blood, pus or mucus (slime)?
Associated vomiting?
Foreign travel?
Medications, including over-the-counter remedies?
What are some causes of RECTAL BLEEDING + what presentation are they associated with?
Haemorrhoids
-> fresh red
-> clearly separate from the stool and may be seen
only on the paper.
-> Bleeding from haemorrhoids may splash into the
pan after a motion
-> generally painless
-> itchiness and discomfort can be seen as well as
feeling on incomplete passage
Carcinoma of the colon or rectum
-> May be associated with mucus
IBD
-> may be mixed with pus or mucus
-> stool may be unformed
Diverticular disease
Anal fissures
-> fresh red
-> associated with severe anal pain during + after
defaecation
Melena
-> severe bleeding from the upper GI tract tends to be
dark in colour (“altered”)
-> may contain clots – the patient may be in shock;
smaller degrees of bleeding may result in dark
stools
What might cause ABDO DISTENSION?
Increasing girth is usually due to adiposity.
Increasing girth in a patient who is otherwise
becoming thinner suggests intra-abdominal disease
—–> subacute bowel obstruction
—–> ascites
—–> ovarian cyst
—–> undiscovered pregnancy
—–> chronic constipation
What do you ask about WEIGHT LOSS / APPETITE CHANGE?
What might cause it?
How much weight loss and over how long?
Associated with loss of appetite or due to deliberate reduction in intake? Weight loss
W/o reduction in food intake?
? diabetes mellitus,
? hyperthyroidism
? malabsorption syndrome.
Loss of appetite may have a non-GI cause e.g. depression.
What do you want to know in the PMH of a GI hx?
Previous / recent surgery?
? HTN / DM / GORD / JAUNDICE / ANAEMIA (IMPORTANT)
? IBS / IBD / COELIAC / GB PROBLEMS
GYNAE PROBLEMS (IF APPLICABLE)
What do you want to know in the FHx of a GI hx?
anyone else in the fam had these sx?
BE SPEICIFC W/ WHAT U SUSPECT
BOWEL Ca
IBD
MALABSORPTION SYNDROMES
GILBERT’S SYNDROME
