History Taking: Abdomen Flashcards
Identify GI symptoms to ask about as part of the history of presenting complaint.
- 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
Identify examples of mouth symptoms.
- Bad breath = halitosis (may be secondary to gingival, dental, pharyngeal infection)
- Dry mouth = xerostomia
- Altered taste = dysgeusia
- Foul taste = cacogeusia
- Gingivitis
What are questions to ask about abdominal pain ?
SOCRATES (where A stands for associated symptoms, and E for exacerbators/relievers)
List the possible sites of abdominal pain.
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
List possible associated symptoms in abdominal pain.
– Sweating / Fevers – Vomiting /nausea – Diarrhoea – Urinary symptoms – Vaginal bleeding / discharge
Identify common exacerbators and relivers of abdominal pain.
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
When asking them about the severity of the pain on a scale of 1 to 10, what does a 10 correspond to ?
Worst pain ever had
What do we mean by anorexia when asking about weight change/anorexia as part of history of presenting complaint ?
Anorexia = reduction in appetite +/or lack of interest in food
What are potential causes of weight gain ?
– Fluid gain e.g. cardiac failure, liver disease, nephrotic syndrome
– Hypothyroidism
– Depression
– Increased energy input/ output ratio
What are potential causes of weight loss ?
– 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
Define heartburn.
Hot burning retrosternal discomfort
What are possible exacerbators of heartburn/reflux ?
Food
Lying flat
Bending forwards
How may patients characterise heartburn/reflux ?
Associated with water brash and acid taste
What is the likely diagnosis with:
- hot burning retrosternal discomfort
- exacerbated by food, lying flat or bending forwards
- water brash and acid taste
GORD (not cardiac)
What are the typical characteristics of dyspepsia as a presenting complaint ?
♦ Pain or discomfort centred in upper abdomen
♦ Exacerbated by food, relieved by antacid (e.g. Gaviscon)
♦ Associated with nausea, belching, bloating
Ingestion is often mentioned by patients as a presenting complaint. What do they mean by that ?
It’s ill defined so you should clarify what they mean
What are the typical characteristics of odynophagia as a presenting complaint ?
Pain on swallowing
Exacerbated by how liquids
+/- dysphagia
What are possible causes of odynophagia ?
Oesophageal ulcers
Oesophagitis
Oesophageal candidiasis
Define dysphagia.
Difficulty in swallowing (=Sensation of obstruction during passage of liquid or solid
food through pharynx or oesophagus’)
What other GI issue is dysphagia often confused with ?
Globus sensation, a feeling of having lump in the throat (when there is in fact none)
What are possible causes of dysphagia ?
ORAL: Painful mouth ulcers
Tonsillitis
NEUROLOGICAL: Cerebrovascular accident
NEUROMUSCULAR: Myasthenia Gravis
Diffuse oesophageal spasm
MECHANICAL: Oesophageal carcinoma Gastric cancer (upper)
What are questions to ask about dysphagia ?
– 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?
What are the different kinds of vomitus ?
- Food
- Bile
- Blood- ‘coffee ground’ or fresh red
What are questions to ask about nausea/vomiting ?
- Frequency and duration ?
- Other symptoms (abdominal pain, diarrhea, constipation) ?
- Pregnancy ?
- Change in medication ?
