History Taking: Abdomen Flashcards
What is the order of taking a medical history (including at which point you would ask GI questions)?
- introduction
- patient ID
- consent
- presenting complaint
- history of presenting complaint (where you ask GI questions)
- past medical history
- drug history and allergies
- family history
- social history
- systems enquiry
What would you ask in the systems enquiry of a medical history?
- CVS: chest pain, palpitations
- RS: shortness of breath, cough
- endocrine: lumps in the neck, weight changes
- MSK: pain/stiffness in joints, muscles or back
- CNS: headaches, funny turns
- GU: changes in waterworks
What are some mouth symptoms of a GI problem?
- bad breath (halitosis)
- dry mouth (xerostomia)
- altered taste (dysgeusia)
- foul taste (cacogeusia)
- cracked painful lips (stomatitis)
What can be causes of bad breath (halitosis)?
- gingivitis
- dental infection
- pharyngeal infection
What are some important questions to ask about pain?
- SOCRATES
- does it stop them doing anything
- can they lie still or are they writhing around?
What are the 9 regions of the abdomen from top to bottom?
- R/L hypochondriac region and epigastric region
- R/L lumbar region and umbilical region
- R/L iliac fossa and hypogastric region
What is colicky pain?
Pain that peaks in intensity and varies
What are common associated symptoms of a GI issue?
- sweating/fevers
- vomiting/nausea
- diarrhoea
- urinary symptoms
- vaginal bleeding/discharge
- weight loss
What are common exacerbators of GI pain?
- eating/not eating
- movement/lack of
- position
- exercise
What are common relievers of GI pain?
- eating/not eating
- vomiting/opening bowels
- movement/lack of
- position
What are some causes of weight gain?
- fluid gain (cardiac failure, liver disease, nephrotic syndrome)
- hypothyroidism
- depression
- increased energy input/output ratio
What are some causes of unexplained weight loss?
- malignancy
- malabsorption
- metabolic disease
- psychiatric causes
- malnutrition
GORD
gastro-oesophageal reflux disease
What can exacerbate heartburn and reflux?
- food
- lying flat
- bending forwards
What is dyspepsia (indigestion), what makes it worse and what are the associated symptoms?
- pain/discomfort centered in upper abdomen
- exacerbated by food
- associated with nausea, belching and bloating
What is odynophagia, what makes it worse and what are the causes?
- pain on swallowing
- exacerbated by hot fluids
- causes: oesophageal ulcers, oesophagitis, oesophgeal candidiasis
What is dysphagia?
- difficulty in swallowing
- NOT globus (lump in throat)
- obstruction during passage of food
- always requires further investigation
Questions to ask about dysphagia
- where do they feel it sticking?
- intermittent/progressive?
- solids/liquids?
- associated symptoms
- pain
- complete obstruction?
- regurgitation?
What are associated symptoms of upper GI bleeding and common causes?
- haematemesis (vomiting blood)
- melaena (passage of black tarry stools - red flag) - bleed
- gastric/duodenal ulcer (50%)
- gastric erosions (15-20%)
What are the associated symptoms of lower GI bleeding and common causes?
- fresh blood
- haemorrhoids/anal fissure/ diverticular disease
What is painless jaundice a sign of?
carcinoma of the head of the pancreas
Questions to ask about jaundice?
- duration
- associated symptoms
- travel
- consumption of shellfish
- blood transfusion
- alcohol
- changes in meds
- IV drug use
- unprotected sex
Constipation causes
- diet/dehydration
- painful anal conditions
- immobility
- medication
- hypothyroidism
- colonic/rectal carcinoma
- neuro
- hypercalcaemia
- irritable bowel syndrome
Diarrhoea causes
- diet
- stress
- infection
- inflammation
- endocrine
- malabsorption
- medication
- irritable bowel syndrome
Upper GI red flags
- dysphagia
- evidence of blood loss
- unexplained weight loss
- upper abdo mass
- unexplained back pain
- painless jaundice
- persistent vomiting
- unexplained iron deficiency anaemia
- unexplained worsening dyspepsia without other symptoms (over 55)
- new onset GI pain (over 55)
Lower GI red flags
- bleeding (rectal bleeding with no cause/in stool)
- changes in bowel habit (persistent esp if looser stools)
- mass (right sided or palpable rectal mass)
- unexplained iron deficiency anaemia
- history of lower GI cancer
