GI History Flashcards
What are the main GI symptoms that we are interested in?
Work your way from top of the GI tract to the bottom
a) Aphthous ulceration – any ulcers in and around your mouth?
b) Difficulty or pain with swallowing? - Dysphagia & Odynophagia – ask about the types of food/liquids they struggle with – tough foods, soft foods and liquids – could be indicative of obstruction.
c) Nausea & Vomiting – any blood (haematemesis)?
d) Heartburn – reflux, regurgitation and water brush
e) Dyspepsia – indigestion – pain, bloating and fullness typically after eating
f) Jaundice
g) Abdominal pain and distention – SOCRATES
h) Altered bowel habits – constipation and diarrhoea – what is normal? How has it changed now?
i) Rectal bleeding – where - wiping, mixed in the stool (haematochezia), black coloured blood (melaena – black and smelly – upper GI bleeding)
j) Steatorrhoea: the presence of excess fat in faeces causing them to appear pale and be difficult to flush
With dyspepsia, what might you be concerned about? What further questions might you be asking?
With dyspepsia – main point of uncertainty – cover heart symptoms
i. SOB
ii. Palpitations
iii. Chest pain (most common)
iv. Syncope (fainting)/pre-syncope
v. Oedema
What systemic symptoms should you ask about in a GI history?
Systemic - Weight Loss , Anorexia – loss of appetite, fever and fatigue – Must Check!
If someone, presents with upper GI symtpoms (pain/discomfort) what other systems could we ask questions about?
If upper GI, we can think about….
Cardiovascular Conditions: chest pain, Breathless, oedema, syncope, palpitations
Respiratory conditions - dyspnoea, cough and chest pain
How to approach PMH for a GI history?
Past Medical History
i. Do you have any other medical conditions associated with your tummy? What about in general, any other medical conditions?
ii. Have you previously undergone any operations or procedures?
What are some commonly perscribed medications for GI conditions?
What are some OTC medications that might impact the GI system?
What are some medications with GI side effects?
Ondansetron - used to prevent nausea and vomiting
How to approach FH for a GI history?
Family History
Any family history of tummy or bowels problems? – clarify the ages when these conditions impacted their relatives.
How to things can you touch on for a GI social history?
General
i. Accommodation they currently reside.
ii. Who else the patient lives with and their personal support network
iii. What tasks they are able to carry out independently and what they require assistance with
iv. If they have any carer input
v. Occupation – Are you currently working?
More Health Related
i. Average Diet
ii. Exercise/activity
iii. Smoking – how many packs/day and for how long
iv. Alcohol – Frequency and quantity
v. Recreational drugs
vi. Sexual activity – are you currently sexually active?
Highlighted are more important to touch on!
Remeber to ask about how it is impacting their life!
What extra things are important to ask about in a GI history?
- Remember to ask about how the condition is impacting their life?
- Potential infective cause – ask about travel – area of travel, diet when travelling, insect bites or consumption of contaminated water.
What is GORD?
- Gastro-intestinal reflux disease (GORD) is a condition characterised by retrosternal, and sometimes epigastric pain, as a result of reflux of the acidic contents of the stomach into the oesophagus.
- There will usually be a problem with the lower oesophageal sphincter (LOS) whereby it doesn’t contract normally.
- People with a hiatus hernia are at a higher risk of developing GORD
What are the clinical features of GORD?
- Dyspepsia (‘Heartburn’) – retrosternal chest pain, particularly after eating - May be worse on lying down, after having had certain foods (alcohol and hot drinks – coffee) or bending over
- Regurgitation of food into the mouth
- Waterbrash – increase in salivation
- Excess belching – burping
- Dysphagia – stricture forms as a result of mucosal damage
What are the risk factors for GORD?
Risk Factors
* Family history of GORD
* Older Age
* Hiatus Hernia
* Obesity
What is an important thing to remember in a GORD history?
- Important to differentiate from any form of cardiac pain – big pointers towards GI aetiology is symptoms associated with eating food and posture/laying down.
- Rule out any other cardiovascular symptoms – any other chest pain, shortness of breath, palpitations, pre-syncope/syncope and oedema.
