GI History Flashcards
Key GI symptoms? (8)
Dysphagia / odynophagia – solids vs liquids
Nausea / vomiting – triggers/ colour of vomit / haematemesis
Reduced appetite / weight loss
Gastroesophageal reflux
Abdominal pain – SOCRATES
Abdominal distension
Altered bowel habit – constipation / diarrhoea / fresh blood / malaena
Systemic symptoms – jaundice / fever / malaise / fatigue
What should you ask regarding the upper GI? (3 and expand)
Mouth – Pain / Ulcers / Growths
Dysphagia – Onset / Progression / Solids and/or liquids
Odynophagia – pain on swallowing – oesophageal candidiasis
What should you ask regarding N&V? (3 and expand)
Frequency and volume – high frequency and volume increases risk of dehydration
Projectile vomiting – obstruction
What does the vomit look like?
Undigested food – pharyngeal pouch / achalasia / oesophageal stricture
Non-bilious vomit – pyloric obstruction (i.e. pyloric stenosis)
Bilious vomit/ faecal matter – lower GI obstruction (i.e. severe constipation)
What should you ask regarding haematemesis? (3 and expand)
Fresh red blood – undigested – acute bleed – Mallory Weiss tear / oesophageal variceal rupture
Coffee ground – digested – bleeding peptic/ duodenal ulcer
Preceded by forceful retching? – Mallory Weiss tear
What should you ask regarding anorexia/weight loss? (3 and expand)
How much weight over how long? – always suspect malignancy – especially in the elderly
Decreased appetite – may suggest malignancy, or in younger patients possibly anorexia nervosa
Pain regional differential diagnoses?
Right iliac fossa – appendicitis / Crohn’s disease Left iliac fossa – diverticulitis Epigastric – gastritis/oesophagitis RUQ – cholecystitis/hepatitis Flank – pyelonephritis Suprapubic – cystitis
Pain duration intermittent/continuous differential diagnoses?
Intermittent – e.g. renal colic/biliary colic/bowel obstruction
Continuous – e.g. cystitis/peritonitis
Causes of bloating? (5)
Fat – obesity Flatus – paralytic ileus/obstruction Faeces – constipation Fluid – ascites Fetus – pregnancy
What should you ask about with diarrhoea? Differentials?
Consistency – how formed is it? (Bristol stool chart)
Mucous – Inflammatory bowel disease (IBD) / Irritable bowel syndrome (IBS)
Blood – Fresh red blood (anal fissure/haemorrhoids/IBD). Melaena (upper gastrointestinal bleed)
Urgency– IBD/IBS/gastroenteritis
Recent antibiotics? – C. Difficile
Recent suspect food? – food poisoning
Laxative use?
What should you ask about with altered bowel habit?
Constipation, colour of stool, diarrhoea
Signs of jaundice?
Yellow skin/eyes and dark urine
Causes of jaundice?
Infectious – hepatitis B and C / malaria
Malignancy – pancreatic cancer / cholangiocarcinoma
Alcoholic liver disease
Autoimmune – autoimmune hepatitis / primary sclerosing cholangitis
Congenital – Gilbert’s syndrome (benign)
GI PMHx?
Gastrointestinal disease – inflammatory bowel disease (IBD) / irritable bowel syndrome / malignancy / gastroesophageal reflux (GORD)
Other medical conditions
Surgical history – e.g. appendectomy / colectomy / c-section
Any recent hospital admissions? – when and why?
GI travel Hx what should you ask? Differentials?
Local food? – e.g. salmonella poisoning
Insect bites? – malaria
Contact with dirty water? – campylobacter / shigella / giardia
GI DHx which drugs particularly?
Laxatives Loperamide Proton pump inhibitors H2 receptor antagonists Sodium alginate/calcium carbonate e.g. Gaviscon
Regular medications – NSAIDS / Steroids /Bisphosphonates – (Gastroduodenal erosions)
Over the counter drugs – NSAIDS / laxatives
Contraception? – consider gynaecological causes of abdominal pain – ectopic pregnancy / miscarriage
