What questions should you ask when inquiring about an individuals history of presenting complaint?
- 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
What are the common mouth symptoms?
- Bad breath - jalitosis
- Dry mouth - xerostomia
- Altered taste - dysgeusia
- Foul taste - cacogeusia
- Gingivitis
What are the 9 regions of the abdomen?
- Epigastric
- R and L hypochondriac
- R and L lumbar
- R and L iliac
- Umbilical
- Hypogastric / Suprapubic
What would you ask when asking about Onset?
Sudden or gradual
How would you ask about the character of the pain?
- “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?
Where does pain radiate in pnacreatitis?
The back
Where does pain radiate when the diaphragm is irritated?
The shoulder tip
What are the associated symproms to do with GI history taking?
- Sweating / Fevers
- Vomitting / nausea
- Diarrhoea
- Urinary symptoms
- Vaginal / bleeding
- Ask about weight loss
What should you ask about timing in the history?
- When
- Still ongoing?
- How long?
- How often?
What are often common aggravating/exacerbating factors?
- Eating / not eating
- Vomiting / opening bowels
- Movement / lack of movement
- Exercise (think cardiac disease)
What are the common relieving factors?
- Eating / no eating
- Vomitting / opening bowels
- Movement / lack of movement
- Position
How would you ask about the severity of the pain?
0 - 10 rating
What does colicky RUQ pain, severe, radiating to below right scapula suggest?
Biliary colic and gallstones
What does epigastric pain with associated mass + dysphagia suggest?
Gastric carcinoma
What does gnawing epigastric pain, remission for weeks/months, exacerbated by food, radiating into the back suggest?
Peptic ulcer
What can cause weight gain?
- Fluid gain e.g cardiac failure, liver disease, nephrotic syndrome
- Hypothyroidism
- Depression
- Increased energy input/output ratio
What may cause 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 abuse e.g. depression / dementia / anorexia nervosa
- Malnutrition
What is heartburn?
Hot burning retrosternal discomfort which is most likely gastro-oesophageal reflux disease
What is dyspepsia?
- Pain or discomfort in the upper abdomen
- Exacerbated by food - relieved by antiacid (Gaviscon)]- Associated with nausea, belching, bloating
- Often called indigestion
What is odynophagia?
- Pain on swallowing
- Exac by hot liquids
What are the potential causes of odynophagia?
- Oesophageal ulcers
- Oesophagitis
- Oesophageal candidiasis
What is dysphagia?
- Means difficulty in swallowing
- Always investigate further
What questions should you ask about dysphagia?
- 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?
What is the commenest cause of serious and life-threatening GI bleeding?
Peptic ulceration
