GI history Flashcards
what is the intro stage?
Hello, my name is L and I am a third year medical student (clean hands)
please can I confirm your name and DoB/ am I speaking to Mr X , please you tell me your DoB
how are you?
I have been told you are having some pain/trouble with bowels/bleeding etc is that correct?
I am going to ask you some questions, is that OK?
Would you like a chaperone/
what is the next step
how can I help you today?
Can you tell me more about pain/bleeding etc?
what to ask regarding pain
Site - epigastric, RUQ
Onset - 1 month, 1 week, an hour ago
Chacteristic- dull ache, sharp, tingling, gnawing
Radiation - shoulder blade, back, jaw
Allevating- rest, vomiting, antacids, deep breaths
Timely- all the time, evenings, mornings, after meals
Exacerbating - NSAIDS, fatty foods
Severity- scale of 0-10
List as many relevant symptom as possible - what can you ask about each.
ask about - onset, characteristic / frequency/ amount/ how long (basically S O C R A T E S ) when relevant.
nausea /vomiting changes in bowels - D and V dysphagia burning sensation bloating belching bleeding - dark or fresh? to differentiate location mucus in stool IBD IBS weight loss flatulence
what is important to ensure
you’ve asked about other symptoms not just focused on one
next step
PMH
- had this before? if so when? how often? diagnosis? and what treatemtnt?
- seen regularly e.g. GP, hospital for diabetes
- been to hosp before? for surgeries e.g. abdo
- gne related
history of anaeia, jaundice and diabetes
then
medication -prescribed or over the counter
relevant to causing symptoms? e.g. iron supplement black stools, anntibiotics- c.dificillle -diarrhoea
nsaids , SSRI
and allergies
then
JADE TAB MARCH
What is the next step
ask about social factors
examples
alcohol diet & exercise smoking recent travel sexual history stuff if relevant occupation
how can you show you care?
how does t impact d 2 d activitiy
show empathy!
then to lead onto what
who they live with and FH
- who, what where when
then
conclude, summarise what been told, thank
what to do to examiner?
report findings, diagnosis, differentials, investigations
what are common causes of pain?
peptic ulcer
pancreatitis
gall stones
describe Socrates of peptic uclers
pain in epigastric region acute/gradual onset 0.5 -3 hrs radiates to back gnawing pain, worsened with hunger, alcohol, aspirin and NSAID eating, antacids and vomiting relieves pain mild to moderate usually
describe Socrates of acute cholecystitis
RUQ, epigastric pain constant, stabbing piercing pain can radiate to scapula or right shoulder associated with fever, vomiting, rigors 3-24 hours worsen with food severe pain
acute pancreatitis
pain in epigastric or central btu may be widespread geeral pain too usually sudden onset radiates to back worsen with fatty food severe pain longer than 24 hours ISTTIGNG uprght relieves stabbig percing pain
describe the IBS pain
colicky lower pain
worse with stress
relieved with defeaction
what else can cause it
S or L bowel obstruction
appendicitis
factors to consider with dysphagia
difficulty swallowing
- solids, liquids?
- higher up pharyngeal pouch, stricture or a global hystericus (sensation of blockage)
lower- osephagitis, cancer, motility issues
when is GORD worrying
mass weight loss no improvement with treatment over 55 males blood new symptom dysphagia
causes of jaundice
associated symptoms
hepatitis - AIH, viral - ask about alcohol, IVD, foreign travel, sex unprotected, FH, blood transfusions ALD liver failure gilbert syndrome gallstones cancer obstruction
fever, pale stool, dark urine
rectal bleeding causes
UC crohns piles haemorrhoids anal fissures colonic cancer diverticular bleed
meleana and haemtessis
peptic ulcer ibd iron supplementation varices gastritis (severe) cancer Liverr failure
drugs which can cause blood in stools
nsaid, aspirin iron supplementation black liceroice pepto bismol -black stools beetroot/tomatoes-reddish
vomiting blood
cancer -lung, pancreatitc Mallory weis tear ulcer -gastric, peptic aspirin liver failure varices nsaids
what is DIEULFOYS LESION
lesion protrudes trhough stomach wall
can cause blood in vom
when can a hernia be seen?
coughing or straining
bulge in groin
mmennoic to remember what to ask ?
ABCDEFGHIJ MNPVW Appetite Bowel habits Constipation Diarrhea/ dysphagia/distention Eating habits Fever Heam in stool Incontinence Jaundice
Medications (Fe tbl, ATB)
Nausea-
vomiting
Pain in abdomen
Weight loss
bloating causes ?
Fat- obesity Flatulence Foetus-pregnant flatus-obstruction fluid-ascites faeces-constipation
progressive dysphagia is associated with?
difficulty solids then liquids- maglinant structure
esp in elderly and if with weight loss and iron def anaemia
what is a must in all!
ICE
