GI History Flashcards
Dysphagia?
Difficulty swallowing
Odynophagia?
Hurts to swallow
What to think with dysphagia/odynophagia?
Malignancy
Heartburn and reflux think?
GORD espescially when lying down
HOWEVER
MI is in the differentials
Anorexia
Loss of appetite
What to think with indigestion?
Peptic ulcer/GORD/ H Pylori
Haematemesis?
Due to upper GI bleeding, above duodenal flexure
PR bleeding- bright red blood?
Sigmoid colon, rectum or anal canal is source
Most commonly heamorrhoids
PR bleeding- darker blood mixed with stool?
Above rectum bleeding, carcinoma is common with this
Melaena?
Bleeding from above ileocaecal valve, tarry, characteristic smell
Tenesmus?
Incomplete emptying feel
-mass in rectum
What is jaundice associated with?
Itching
What to think with abdo pain?
- Region
- Radiation
- Colicky
- Localised/diffuse
- Association with eating/defecation/vomiting
- Improvement or worsening with position
- SOCRATES
Past medical history?
- Specifically ask about hypertension, high cholesterol, diabetes
- Previous conditions
- Ask how they’re managing long term conditions eg IBD
Drug history?
- Don’t forget OTC medication
- Allergies
- Steroids relevant for pancreatitis
- IV drug users
Family History?
Coeliac
IBD
GI cancers
Social History?
- Travel history
- Restaurant
- Contact with other vomiters/diarrhoea
- Lifestyle
- Blood contamination/sexual history
Physical examination?
- Inspection= distension, scars, bruising
- General Exam
- Before palpating- asl about discomfort and start away from that area, telling them what you’re doing
- Palpate abdomen in all 9 quadrants, first light then deeper, looking at face
Assess for organomegaly?
Liver- start RIF and ask them to breath in while scooping upwards to catch liver edge
Spleen= Start in RIF and move towards LUQ with scooping motion. Spleen not felt unless pathology present
Ballot the kidney?
Place hand over back at level of kidney and other hand on abdomen. Flick the hand on the back to feel for enlarged kidney
After feeling for big organs you?
- Percuss the liver and spleen
- Listen for bowel sounds and renal bruits
- Groin hernias
PR exam?
- Make it clear you can stop at any time, practice communication
- Recommend a chaperone
What bin does all the stuff from PR exam go in?
ORANGE bin