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MD3002 Clinical > History Taking Abdomen > Flashcards

History Taking Abdomen Flashcards

1
Q

What questions should you ask when inquiring about an individuals history of presenting complaint?

A
  • Mouth Symptoms
  • Abdominal pain
  • Anorexia and weight change
  • Heartburn and reflux
  • Dyspepsia and indigestion
  • Odynophagia and dysphagia
  • Abdominal disrension and swellings/lumps
  • Nausea and vomitting
  • GI tract bleeding
  • Jaundice
  • Change in bowel habit - constipation / diarrhoea
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2
Q

What are the common mouth symptoms?

A
  • Bad breath - jalitosis
  • Dry mouth - xerostomia
  • Altered taste - dysgeusia
  • Foul taste - cacogeusia
  • Gingivitis
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3
Q

What are the 9 regions of the abdomen?

A
  • Epigastric
  • R and L hypochondriac
  • R and L lumbar
  • R and L iliac
  • Umbilical
  • Hypogastric / Suprapubic
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4
Q

What would you ask when asking about Onset?

A

Sudden or gradual

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5
Q

How would you ask about the character of the pain?

A
  • “How would you desribe the pain?”
  • Sharp / Dull / Burning / Throbbing / Stabbing / Colicky / Crampy
  • Watch their hands - do they use a single finer, spread out their hand or ball up their fist?
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6
Q

Where does pain radiate in pnacreatitis?

A

The back

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7
Q

Where does pain radiate when the diaphragm is irritated?

A

The shoulder tip

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8
Q

What are the associated symproms to do with GI history taking?

A
  • Sweating / Fevers
  • Vomitting / nausea
  • Diarrhoea
  • Urinary symptoms
  • Vaginal / bleeding
  • Ask about weight loss
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9
Q

What should you ask about timing in the history?

A
  • When
  • Still ongoing?
  • How long?
  • How often?
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10
Q

What are often common aggravating/exacerbating factors?

A
  • Eating / not eating
  • Vomiting / opening bowels
  • Movement / lack of movement
  • Exercise (think cardiac disease)
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11
Q

What are the common relieving factors?

A
  • Eating / no eating
  • Vomitting / opening bowels
  • Movement / lack of movement
  • Position
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12
Q

How would you ask about the severity of the pain?

A

0 - 10 rating

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13
Q

What does colicky RUQ pain, severe, radiating to below right scapula suggest?

A

Biliary colic and gallstones

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14
Q

What does epigastric pain with associated mass + dysphagia suggest?

A

Gastric carcinoma

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15
Q

What does gnawing epigastric pain, remission for weeks/months, exacerbated by food, radiating into the back suggest?

A

Peptic ulcer

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16
Q

What can cause weight gain?

A
  • Fluid gain e.g cardiac failure, liver disease, nephrotic syndrome
  • Hypothyroidism
  • Depression
  • Increased energy input/output ratio
17
Q

What may cause 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 abuse e.g. depression / dementia / anorexia nervosa
  • Malnutrition
18
Q

What is heartburn?

A

Hot burning retrosternal discomfort which is most likely gastro-oesophageal reflux disease

19
Q

What is dyspepsia?

A
  • Pain or discomfort in the upper abdomen
  • Exacerbated by food - relieved by antiacid (Gaviscon)]- Associated with nausea, belching, bloating
  • Often called indigestion
20
Q

What is odynophagia?

A
  • Pain on swallowing

- Exac by hot liquids

21
Q

What are the potential causes of odynophagia?

A
  • Oesophageal ulcers
  • Oesophagitis
  • Oesophageal candidiasis
22
Q

What is dysphagia?

A
  • Means difficulty in swallowing

- Always investigate further

23
Q

What questions should you ask about dysphagia?

A
  • Where do you feel it sticking?
  • Intermittent / progressive?
  • Solids / liquids?
  • Associated symptoms e.g heart burn / weight loss
  • Pain - odynophagia
  • Complete obstruction and regurgitation of foodstuff?
24
Q

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

A

Peptic ulceration

25
Q

What can black stools / Melaena indicate?

A
  • Usually secondary to bleed in oesphagus, stomach or duodenum
  • Most commonly caused by chronic peptic ulceration
  • Also can appear dark when taking oral iron
26
Q

What can cause lower GI tract bleeding?

A
  • Haemorrhoids
  • Anal fissure
  • Diverticular disease
  • Large bowel polyps or carcinoma
  • Inflammatory bowel disease
27
Q

What does painless jaundice indicate?

A

Carcinoma of head of pancreas

28
Q

What are common causes of constipation?

A
  • Diet / dehydration
  • Painful anal conditions (e.g anal fissure)
  • Immobility
  • Medication e.g opiates
  • Hypothyroidism
  • Colonic / rectal carcinoma
  • Neuromuscular e.g spinal chord disease / Parkinson’s disease
  • Hypercalcaemia (may be related to malignancy)
  • IBS
29
Q

WHat are common causes of diarrhoea?

A
  • Diet
  • Stress
  • Infection (e.g viral gastroenteritis / food poisoning)
  • Inflammation e.g ulcerativ colitis / Crohn’s
  • Endocrine e.g hyperthyroidism
  • Malabsorption e.g coeliac disease / pancreatic disease
  • medication
  • IBS
30
Q

What are the upper GI tract red flags?

A
  • Dysphagia
  • Evidence of blood loss
  • Unexplained weight loss
  • Upper abdominal or epigastric mass
  • Unexplained back pain
  • Painless jaundice
  • Persistant vomitting
  • Unexpalined iron deficiency anaemia
  • Unexplained worsening dyspepsia without other symptoms if 55 > yrs old
  • New onset upper GI pain if >55 yrs old OR if risk factor (e.g. +ve FH)
31
Q

What are the red flags of lower GI tract bleeding?

A
  • Repeated rectal bleeding without an obvious anal cause
  • Any blood mixed in with stools
  • Persistant change in bowel habit especially to looser stools (more than 4 weeks)
  • Right sided abdominal mass
  • Palpable rectal mass
  • Unexplained iron deficiency anaemia
  • Past history of lower GI cancer with any of the symptoms above
32
Q

What are the casues of jaundice?

A
  • Pre-hepatic / Hepatic / Post-hepatic
33
Q

What questions should you ask in relation to jaundice?

A
  • Duration
  • Associated symptoms (pain, weight loss, fevers)
  • Colour of stool and urine
  • Travel
  • Consumption of shellfish
  • Blood transfusion
  • Alcohol consumption
  • Changes in medication
  • IV drug use
  • Unprotected sex
34
Q

What are the main causes of GI tract bleeding?

A
  • Gastric or duodenal canceer (50%)
  • GAstric erosions (15-20%)
  • Varices (10-20%)
  • Mallory-Weiss syndrome (5-10%)
  • Reflux oesophagitis (2-5%)
  • Gastric carcinoma (uncommon)

MD3002 Clinical (4 decks)

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