GI history

Question 1

what is the intro stage?

Answer 1

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/

Question 2

what is the next step

Answer 2

how can I help you today?

Can you tell me more about pain/bleeding etc?

Question 3

what to ask regarding pain

Answer 3

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

Question 4

List as many relevant symptom as possible - what can you ask about each.

Answer 4

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

Question 5

what is important to ensure

Answer 5

you’ve asked about other symptoms not just focused on one

Question 6

next step

Answer 6

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

Question 7

then

Answer 7

medication -prescribed or over the counter

relevant to causing symptoms? e.g. iron supplement black stools, anntibiotics- c.dificillle -diarrhoea
nsaids , SSRI
and allergies

Question 8

then

Answer 8

JADE TAB MARCH

Question 9

What is the next step

Answer 9

ask about social factors

Question 10

examples

Answer 10

alcohol
diet  & exercise
smoking
recent travel
sexual history stuff if relevant
occupation

Question 11

how can you show you care?

Answer 11

how does t impact d 2 d activitiy

show empathy!

Question 12

then to lead onto what

Answer 12

who they live with and FH

- who, what where when

Question 13

then

Answer 13

conclude, summarise what been told, thank

Question 14

what to do to examiner?

Answer 14

report findings, diagnosis, differentials, investigations

Question 15

what are common causes of pain?

Answer 15

peptic ulcer
pancreatitis
gall stones

Question 16

describe Socrates of peptic uclers

Answer 16

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

Question 17

describe Socrates of acute cholecystitis

Answer 17

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

Question 18

acute pancreatitis

Answer 18

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

Question 19

describe the IBS pain

Answer 19

colicky lower pain
worse with stress
relieved with defeaction

Question 20

what else can cause it

Answer 20

S or L bowel obstruction

appendicitis

Question 21

factors to consider with dysphagia

Answer 21

difficulty swallowing
- solids, liquids?
- higher up pharyngeal pouch, stricture or a global hystericus (sensation of blockage)
lower- osephagitis, cancer, motility issues

Question 22

when is GORD worrying

Answer 22

mass 
weight loss
no improvement with treatment 
over 55 
males 
blood 
new symptom 
dysphagia

Question 23

causes of jaundice

associated symptoms

Answer 23

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

Question 24

rectal bleeding causes

Answer 24

UC crohns 
piles haemorrhoids
anal fissures
colonic cancer 
diverticular bleed

Question 25

meleana and haemtessis

Answer 25

peptic ulcer 
ibd 
iron supplementation 
varices  
gastritis (severe)
cancer 
Liverr  failure

Question 26

drugs which can cause blood in stools

Answer 26

nsaid, aspirin
iron supplementation 
black liceroice 
pepto bismol -black stools 
beetroot/tomatoes-reddish

Question 27

vomiting blood

Answer 27

cancer -lung, pancreatitc
Mallory weis tear 
ulcer -gastric, peptic 
aspirin 
liver failure 
varices 
nsaids

Question 28

what is DIEULFOYS LESION

Answer 28

lesion protrudes trhough stomach wall

can cause blood in vom

Question 29

when can a hernia be seen?

Answer 29

coughing or straining

bulge in groin

Question 30

mmennoic to remember what to ask ?

Answer 30

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

Question 31

bloating causes ?

Answer 31

Fat- obesity
Flatulence
Foetus-pregnant 
flatus-obstruction 
fluid-ascites 
faeces-constipation

Question 32

progressive dysphagia is associated with?

Answer 32

difficulty solids then liquids- maglinant structure

esp in elderly and if with weight loss and iron def anaemia

Question 33

what is a must in all!

Answer 33

ICE