History Taking: Abdomen Flashcards

1
Q

Identify GI symptoms to ask about as part of the history of presenting complaint.

A
  • Mouth symptoms
  • Abdominal pain
  • Anorexia and weight change
  • Heartburn and reflux
  • Dyspepsia and indigestion
  • Odynophagia and dysphagia
  • Abdominal distension and swellings / lumps
  • Nausea and vomiting
  • GI tract bleeding (Haematemesis, malaena)
  • Jaundice
  • Change in bowel habit – constipation / diarrhoea
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2
Q

Identify examples of mouth symptoms.

A
  • Bad breath = halitosis (may be secondary to gingival, dental, pharyngeal infection)
  • Dry mouth = xerostomia
  • Altered taste = dysgeusia
  • Foul taste = cacogeusia
  • Gingivitis
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3
Q

What are questions to ask about abdominal pain ?

A

SOCRATES (where A stands for associated symptoms, and E for exacerbators/relievers)

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4
Q

List the possible sites of abdominal pain.

A

9 regions:

  • Right hypochondriac region (R hypochondrium)
  • Epigastric region
  • Left hypochondriac region (L hypochondrium)
  • Right lumbar region (R flank, loin)
  • Umbilical region
  • Left lumbar region (L flank)
  • Right iliac/inguinal region (R iliac fossa, groin)
  • Hypogastric region (pubic, suprapubic region)
  • Left iliac/inguinal region (L iliac fossa, groin)
4 quadrants (separated by an transumbilical plane at level of L3/4 intravertebral disc, and a median plane, through xiphoid process and pubic symphysis) 
Upper R
Upper L 
Lower R
Lower L
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5
Q

List possible associated symptoms in abdominal pain.

A
– Sweating / Fevers
– Vomiting /nausea
– Diarrhoea
– Urinary symptoms
– Vaginal bleeding / discharge
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6
Q

Identify common exacerbators and relivers of abdominal pain.

A
Exacerbators: 
– Eating/not eating
– Movement/lack of movement 
– Position
– Exercise (think cardiac disease)
Relievers: 
– Eating/not eating
– Movement/lack of movement 
– Position
– Vomiting/opening bowels
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7
Q

When asking them about the severity of the pain on a scale of 1 to 10, what does a 10 correspond to ?

A

Worst pain ever had

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8
Q

What do we mean by anorexia when asking about weight change/anorexia as part of history of presenting complaint ?

A

Anorexia = reduction in appetite +/or lack of interest in food

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9
Q

What are potential causes of weight gain ?

A

– Fluid gain e.g. cardiac failure, liver disease, nephrotic syndrome
– Hypothyroidism
– Depression
– Increased energy input/ output ratio

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10
Q

What are potential causes of weight loss ?

A

– Malignancy
– Malabsorption e.g. chronic pancreatitis/ coeliac disease/ Crohn’s disease
– Metabolic diseases e.g. diabetes, hyperthyroidism, renal disease, chronic infection (TB/ HIV)
– Psychiatric causes e.g. depression/ dementia/ anorexia nervosa
– Malnutrition

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11
Q

Define heartburn.

A

Hot burning retrosternal discomfort

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12
Q

What are possible exacerbators of heartburn/reflux ?

A

Food
Lying flat
Bending forwards

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13
Q

How may patients characterise heartburn/reflux ?

A

Associated with water brash and acid taste

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14
Q

What is the likely diagnosis with:

  • hot burning retrosternal discomfort
  • exacerbated by food, lying flat or bending forwards
  • water brash and acid taste
A

GORD (not cardiac)

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15
Q

What are the typical characteristics of dyspepsia as a presenting complaint ?

A

♦ Pain or discomfort centred in upper abdomen
♦ Exacerbated by food, relieved by antacid (e.g. Gaviscon)
♦ Associated with nausea, belching, bloating

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16
Q

Ingestion is often mentioned by patients as a presenting complaint. What do they mean by that ?

A

It’s ill defined so you should clarify what they mean

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17
Q

What are the typical characteristics of odynophagia as a presenting complaint ?

A

Pain on swallowing
Exacerbated by how liquids
+/- dysphagia

18
Q

What are possible causes of odynophagia ?

A

Oesophageal ulcers
Oesophagitis
Oesophageal candidiasis

19
Q

Define dysphagia.

A

Difficulty in swallowing (=Sensation of obstruction during passage of liquid or solid
food through pharynx or oesophagus’)

20
Q

What other GI issue is dysphagia often confused with ?

A

Globus sensation, a feeling of having lump in the throat (when there is in fact none)

21
Q

What are possible causes of dysphagia ?

A

ORAL: Painful mouth ulcers
Tonsillitis

NEUROLOGICAL: Cerebrovascular accident

NEUROMUSCULAR: Myasthenia Gravis
Diffuse oesophageal spasm

MECHANICAL: Oesophageal carcinoma
Gastric cancer (upper)
22
Q

What are questions to ask about dysphagia ?

A

– Where do they feel it sticking?
– Intermittent / progressive?
– Solids / liquids?
– Associated symptoms e.g. heartburn / weight loss
– Pain- odynophagia
– Complete obstruction and regurgitation of foodstuffs?

23
Q

What are the different kinds of vomitus ?

A
  • Food
  • Bile
  • Blood- ‘coffee ground’ or fresh red
24
Q

What are questions to ask about nausea/vomiting ?

A
  • Frequency and duration ?
  • Other symptoms (abdominal pain, diarrhea, constipation) ?
  • Pregnancy ?
  • Change in medication ?
25
Q

Identify and define the main kinds of GI tract bleeding.

A

Haematemesis (upper GI tract bleeding, i.e. vomiting blood – fresh red or ‘coffee-ground’)

Melaena (upper GI tract bleeding, i.e. passage of black tarry stools)

Lower GI tract bleeding (usually fresh red blood)

26
Q

What are possible causes of haematemesis ?

A

Gastric or duodenal ulcer
Gastric erosions
Varices

27
Q

What is the the commonest cause of serious and life-threatening GI bleeding ?

A

Peptic ulceration

28
Q

What are possible causes of malaena ?

A

Bleeding in stomach, esophagus, duodenum

Most commonly chronic peptic ulcers

29
Q

What is a possible other reason for dark stools other than upper GI bleeding.

A

Taking oral iron

30
Q

What are associated symptoms with lower GI tract bleeding ?

A

Diarrhoea, constipation, abdominal pain

31
Q

What are questions to ask about lower GI tract bleeding ?

A

Duration and frequency?
Is it mixed with stool?
Associated symptoms?

32
Q

What are causes of lower GI tract bleeding ?

A

Haemorrhoids
Anal fissure
Large bowel polyps or carcinoma

33
Q

Define jaundice.

A

Yellow discolouration of sclerae / skin

34
Q

Identify possible causes of jaundice.

A

Pre-hepatic
Hepatic
Post-hepatic

35
Q

What are questions to ask about jaundice ?

A

Duration
Associated symptoms (pain, weight loss, fevers)
Colour of stool and urine
Travel

36
Q

What is the likely diagnosis for painless jaundice.

A

Carcinoma of head of pancreas

37
Q

What is meant by “persistent” in persistent change in bowel habit ?

A

> 4 weeks

38
Q

What are possible questions to ask about persistent changes in bowel habit ?

A

Duration
Colour of stool (mucous / fresh or altered blood)
Constipation or diarrhea or mix of both

39
Q

What are possible causes of constipation ?

A
  • Diet/dehydration
  • Painful anal conditions (e.g. anal fissure)
  • Immobility
  • Medication (e.g. opiates)
40
Q

What are possible causes of diarrhea ?

A
  • Diet
  • Stress
  • Infection (e.g. viral gastroenteritis)
  • Inflammation (e.g. Crohn’s)
41
Q

Identify upper GI tract red flags.

A
  • Dysphagia
  • Evidence of blood loss
  • Unexplained weight loss
  • Painless jaundice
  • Persistent vomiting
42
Q

Identify lower GI tract red flags (suspicion of cancer).

A
  • Persistant rectal bleeding without obvious anal cause
  • Blood mixed with stools
  • Palpable rectal mass
  • Unexplained iron deficiency anaemia