GI history Flashcards
What to ask about the mouth in a GI history?
Ulcer
Chewing/swallowing
Diet
Saliva/dry mouth
appetite
Taste
What does metallic taste signal
GORD - bile
What to ask about indigestion
come back up - what sick looks like
SOCRATES
Heart burn, after eat
Red flags GI
Weight loss unexplained
Change in bowel habit - erratically, especially over 50s
Blood in stool
Unknown cause of Iron deficiency anaemia in older poeple
Questions around stomach
Comitting - what looks like, frequency, volume
Pain - SOCRATES
Appetite
Bloating
Intestinal questions
Flatulaence
Bloating
Continence
Change bowel habit
What is normal bowel habit
Relative but normally 3 x a day to once every 3 days
Rectal questions
Blood, mucus, when and where see and volume
GI meds to ask about
Laxatives, loperamide, buscapan, mebavarine, peppermint oil
Questions to ask about diarrhoea
What do you mean by diarrhoea?Any blood in the stool? Is it mixed in the stool or just on the toilet paper?Any history of foreign travel?Any unexplained weight loss?
Any associated abdominal pain?
Any nocturnal symptoms?
Any fevers?
What is a red flag with chronic diarrhoea, but less so in menstruating women?
Iron deficiency anaemia
What is an apthlous ulcer? What are they ;linked to?
Mouth ulcer
What is an apthlous ulcer? What are they ;linked to?
Mouth ulcer, crohns
What is dermatitis herpateformis and what disease is it linked to?
Blisters flled with watery fluid intensely itchy. Made use by eating gluten
What is erythema nodosum? What are they linked to?
Painful red marks on shins. IBD
What does faecal calprotectin investigate?
If negative rules out IBD, if + doesnt diagnose but could be -> colonoscopy
What marker is not raised in coeliac disease?
Faecal calprotectin
What to check for in recent antibiotic use and acute diarrhoea
C.difficile
Why does recent antibiotic use increase the risk of C.difficile?
Act on GI tract on healthy bacteria, which no longer keep C.difficile in check form multiplying
Risk factors for C.difficile
- Antibiotic exposure - any
- > 65
- Hospital or institiutional care
- Prev C.difficle illness
- Multiple existing illnesses
- Institutional exposure to another patinet with C difficile
- Immunocompromised status incl chemotherapy
- Lack of antitoxin antibodies, poor antitoxin response
- Procedures or treatment that modify normal flora of the bowel, esp the colon
- PPIs
What antibiotics are at greater risk of causing C.difficile?
Moderate
- Macrolides
- Amoxicillin/claculanic acid/ampicillin
- Tetracycclines
- First generation cephalosporins
- Cotrimaxazole
High
- Clindamycin
- Advanced cephalosporin like
- Carbapenems
- Fluroquinolones
C diff positive culture but negative toxin n
C DIFF COLONISATION CONFIRMEDBUT POSSIBLY NOT CAUSINGSYMPTOMS (see previous)
