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MD3002 - GI Clinical > History Taking: Gastrointestinal System > Flashcards

History Taking: Gastrointestinal System Flashcards

1
Q

Outline the 7 questions asked when taking a history

A
  1. Presenting Complaint
  2. History of Presenting Complaint
  3. Past Medical History
  4. Drug History
  5. Family History
  6. Social History
  7. Systems Enquiry/review
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2
Q

What are the main areas asked about in a GI history?

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
  • Jaundice
  • Change un bowel habits – constipation /diarrhoea
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3
Q

What are the 4 most common mouth symptoms?

A
  • Bad breath – halitosis – secondary to gingival, dental, pharyngeal infections
  • Dry mouth – xerostomia
  • Altered taste – dysgeusia
  • Foul taste – cacogeusia
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4
Q

Give the 9 potential sites of pain in the abdomen

A
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5
Q

Give the socrates for the pain associated with peptic ulcer

A

S - Epigastrium

O - Gradual

C - Gnawing

R - Radiating into back

A - Non-specific associated symptoms

T - remission for weeks/months; noctural and especially when hungry; 0.5-2hrs

E - Stress, spicy foods, alcohol, NSAIDs

R - antacids, food, vomiting

S - Mild to moderate

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6
Q

Give the socrates assoicated with biliary colic

A

S - Epigastrium/right hypochondrium

O - rapidly increasing

C - constant

R - radiates to below right scapula

A - non-specific

T - attacks can be enumerated; unpredictable; 4-24hrs

E - eating (unable to eat during bouts)

R - None

S - severe

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7
Q

Give the socrates associated with acute pancreatitis

A

S - epigastrium/left hypochondirum

O - sudden

C - constant

R - radiates into back

A - non-specific

T - attached can be enumerated; after heavy dribking, >24hrs

E - alcohol, eating (cannot during bouts0

R - sitting upright

S - severe

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8
Q

Give the socrates of renal colic

A

S - loin

O - rapidly increasing

C - constant

R - into genetilia and inner thigh

A - non-specific

T - discrete episode; following dehydration; 4-24hrs

E - n/a

R - n/a

S - severe

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9
Q

What to consider with Colicky RUQ pain, severe, radiating to below right scapula

A

biliary colic and gallstones

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10
Q

What to consider with Epigastric pain with associated mass and dysphagia

A

gastric carcinoma

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11
Q

What to cinsider with Gnawing epigastric pain, remission for weeks/months, exacerbated by food, radiating into back

A

peptic ulcer

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12
Q

Major 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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13
Q

Major causes of weightloss

A
  • Malignancy
  • Malabsorption e.g. chronic pancreatitis, coeliac disease, Chron’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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14
Q

What is heartburn?

A

hot burning retrosternal discomfort

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15
Q

What can heart burn be exacerbated by?

A

exacerbated by food, lying flat or bending forwards

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16
Q

What is the most likely Gi causes of heartburn?

A

gastro-oesophageal reflux disease (GORD) is likely

17
Q

What is dyspepsia and what is it exacerbated by?

A
  • Pain or discomfort centred in upper abdomen
  • Exacerbated by food – relived by antacid (Gaviscon)
18
Q

What is assoicated with dyspepsia?

A

nausea, belching and bloating

19
Q

What is odynophagia and what is it exacerbated by?

A
  • Pain on swallowing
  • Exacerbated by hot liquids
20
Q

Potential causes of odynophagia

A

oesophageal ulcers, oesophagitis, oesophageal candidiasis

21
Q

What is dysphagia?

A

difficulty swallowing

22
Q

oral causes of dysphagia

A
  • Painful mouth ulcers
  • Tonsillitis/pharyngitis/glandular fever
23
Q

Neurological causes of dysphagia

A
  • CVA
  • Bulbar or pseudobulbar palsy
24
Q

Neuromuscular causes of dysphagia?

A
  • Achalasia
  • Pharyngeal pouch
  • Myasthenia Gravis
  • Diffuse oesophageal spasm
25
Q

Mechanical causes of dysphagia

A
  • Oesophageal carcinoma
  • Gastric cancer (upper)
  • Peptic oesophagitis
  • Benign stricture
  • Extrinsic compression (lung tumour, lymph nodes, goitre)
26
Q

What is haematemesis?

A

vomiting blood

27
Q

Causes of upper GI tract bleeding?

A
  • Gastric or duodenal ulcer (50%)
  • Gastric erosions (15-20%)
  • Varices (10-20%)
  • Mallory-Weiss syndrome (5-10%)
  • Reflex oesophagitis (2-5%)
  • Gastric carcinoma (uncommon)
28
Q

What is melana?

A
  • Passage of black tarry stools
  • Usually secondary to bleed in oesophagus, stomach or duodenum
  • Most commonly caused by chronic peptic ulceration
29
Q

Causes of lower GI tract bleeding?

A
  • Haemorrhoids
  • Anal fissure
  • Diverticular disease
  • Large bowel polyps or carcinoma
  • Inflammatory bowel disease
30
Q

What is jaundice?

A

Yellow discolouration of sclerae/skin

31
Q

What are the most common causes of constipation?

A
  • Diet/dehydration
  • Painful anal conditions (e.g. anal fissure)
  • Immobility
  • Medication – opiates
  • Hypothyroidism
  • Colonic/rectal carcinoma
  • Neuromuscular – spinal cord disease/ Parkinson’s disease
  • Hypercalcaemia (may be related to malignancy
  • Irritable bowel syndrome
32
Q

What are the most common causes of diarrhoea?

A
  • Diet
  • Stress
  • Infection – viral gastroenteritis, food poisoning
  • Inflammation – ulcerative colitis, Crohn’s
  • Endocrine – hyperthyroidism
  • Malabsorption – coeliac disease, pancreatic disease
  • Medication
  • Irritable bowel syndrome
33
Q

What are the main upper GI Tract red flags?

A
  • Dysphagia
  • Evidence of blood loss
  • Unexplained weight loss
  • Upper abdominal or epigastric mass
  • Unexplained back pain
  • Painless jaundice
  • Persistent vomiting
  • Unexplained iron deficiency anaemia
  • Unexplained worsening of dyspepsia without other symptoms If >55 years old
  • New onset upper GI pain if >55 years old OR if risk factor (e.g. +ve FH)
34
Q

What does painless jaundice suggest?

A

carcinoma of the head of pancreas

35
Q

What are the lower GI tract red flags?

A
  • Bleeding
    • rectal bleeding withour obvious cause
    • blood mixed with stool
  • Bowel habit
    • change - esp. to looser stools
  • Mass
    • right-sided abdominal mass
    • palpable rectal mass
  • Iron deficiency anaemia

MD3002 - GI Clinical (3 decks)

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