GI history and examination Flashcards
What should you enquire about in a GI history?
Pain Abdominal distension N&V Dysphasia Dyspepsia, hiatus hernia and peptic ulceration Hx of gallstones/previous pancreatitis Jaundice Altered bowel habit, diarrhoea, constipation, alternating diarrhoea/constipation Blood loss Mucus/slime per rectum Appetite Weight changes Continence
What should you ask in a vomiting history?
How frequent?
What time of day?
Taste/colour/smell/quantity?
Blood in vomit? Fresh altered blood?
What should you ask about in a dysphasia history?
Continuous/intermittent? How long does it last for? Where does the food stick? Solids/liquids/both? Does it occur between meals? Do you suffer from acid reflux/dyspepsia? Nocturnal coughing or dyspnoea? Enquire about risk factors for oesophageal carcinoma - smoking, alcohol, obesity and diet lacking in fruit and veg
What should you ask in a jaundice history?
Colour of urine and stools? Hx of gallstones? Pain? Fever and rigors? Itching? Social history - alcohol, drugs, foreign travel, unprotected sex
What should you ask in an altered bowel habit history?
How has the habit altered? Frequency of stools? Any associated abdominal discomfort or urgency? Incontinence? Appearance of stool? Consistency (formed/unformed)? Does it float? Associated blood/pus/mucus? Associated vomiting? Foreign travel? Medications including OTC?
What can cause rectal bleeding?
Haemorrhoids Carcinoma IBD Anal fissures Melena
What should you ask in a weight loss and loss of appetite history?
How much weight lost? Over how long?
Associated with loss of appetite or due to deliberate reduction in intake?
What should you ask about in a GI PM history?
Previous GI problems, diagnoses, effectiveness of treatment
Previous GI/abdominal surgery
Gynaecological problems
Hx of jaundice, anaemia, diabetes
What should you ask in a drug history?
Iron tablets Opiates NSAIDs Antibiotics Anticoagulants SSRIs
What should you ask about in a social history?
Alcohol Smoking Occupation Diet Recent foreign travel
What should you ask about in a family history?
Cancers Crohn's disease Ulcerative colitis Malabsorption syndromes Gilbert's syndrome
What are the steps in a GI examination?
Inspection Palpation Percussion Auscultation Special tests
What should you inspect?
General inspection Hands Forearms and armpits Eyes Face Mouth Chest wall Abdomen - posterior and anterior
What should you look for in the hands?
Colour - pallor of palmar creases, palmar erythema Temperature Clubbing Leukonychia Koilonychia Spider naevi Dupuytren's contracture Asterixis
What do you look for in the forearms and arm pits?
Muscle wasting
Bruising
Scratches suggestive of pruritis
Acanthosis nigricans
What should you look for in the eyes?
Jaundice Anaemia Xanthelasma Corneal arcus Kayser-Fleischer rings
What should you look for in the face?
Telangiectasia
What should you look for in the mouth?
Telangiectasia (HHT) Pigmentation Angular stomatitis (vit B6/12/folate/iron deficiency) Glossitis (vit B12/folate deficiency/iron) Dehydration Halitosis Dental caries Ulcers
What should you examine the chest wall for?
Spider naevi
Gynaecomastia
What do you inspect the abdomen for?
Scars Skin Shape/symmetry Movement during breathing Visible swellings and masses Visible peristalsis Visible aortic pulsation Distended veins 5Fs of abdominal fluid distension
What do you palpate?
Pulse BP Lymph nodes in neck and lymph nodes in inguinal region 9 regions of abdominal wall - Liver - Spleen - Bladder - Kidneys - Gallbladder - Aorta
Which lymph node is important to palpate?
Virchow’s lymph node in L supraclavicular fossa
What do you percuss?
Liver
Spleen
Bladder
Ascites - shifting dullness
What do you auscultate?
Bowel sounds
Aortic and femoral bruits
How do you finish a GI examination?
ISHRUG Inspection of inguinal lymph nodes Stool sample Hernial orifices Rectal examination Urine sample Genitalia
