Peptic Ulcer Flashcards
CLERKING
Case: Take a focused history from this 28 year old man who presented with complaints of pain at the epigastrum x 1 month, vomiting x 5 days.
vomiting × 5 days.
1. Greet examiner: Good afternoon sir/ma, my name is ***,can I go ahead sir/ma?
Greet Patient:
G=Greet: Good afternoon sir
=Rapport: How are you doing today sir?
I=Introduce: My name is **, a candidate of the MDCN exam.
P=Permission: For the purpose of this exam, I will like to take a focused history from you. Can I go ahead?
2. BIODATA:
NASOMART: Name, Age, Sex, Occupation, Marital Status, Address, Religion, Tribe.
3. Presenting complaints: Epigastric pain x 1 month, vomiting × 5 days
4. History of presenting complaints:
5 C’s (complaints, course, cause, complications, care so far)
Epigastric pain using SOCRATES:
Site: Where do you feel the pain? Show with one finger.
Onset: How did it start? Sudden or gradual onset?
Character: -Please describe the pain. E.g sudden cramp-like pain (colicky), Sharp/stabbing, Dull, aching, burning.
-Is pain constant or comes and goes (intermittent)?
Course: Since it started, has it gotten worse or better?
Radiation: Do you feel the pain any other place?
e.g Back (PUD, pancreatitis), groin/genitals (renal/ureteric
colic), Shoulder (gall bladder), Loin (pyelonephritis), Chest (MI)
Associated symptoms: Abd distension, constipation, diarrhea etc
Timing: When do you feel the pain? At night? Before or after eating?
Exacerbating/relieving factors:
Exacerbating factors: What worsens the pain?
e.g eating? If yes (mostly peppery foods (GU), fatty meals (acute cholecystitis)
Hunger? Does breathing in deeply or coughing make it worse? - gatritis or pancreatitis
Relieving: What relieves the pain? E.g food, hunger, vomiting, antacids, leaning forward - posture, rest?
Severity: Does the pain affect your daily activity or sleep?
Vomiting - DOCTOR
Duration: How many episodes?
How many times have patient vomited and the number of times patient has vomited on the day you are clerking?
Onset: How did it start?
Character: - Quantity (estimate in mls)- quantify amount of vomitus per episode using a cup or pure sachet.
- Is it projectile or not?
- Is it effortful or effortless?
- Content: (is it blood stained? If yes, fresh or altered blood- coffee appearance), Bile stained (greenish) or contains recently ingested meal? Mucus?)
- Odor: is it odourless or foulsmelling?
- Is it painful or painless?
Timing: is it associated with eating?
Other symptoms: Diarrhea, constipation etc
Related Phenomenon: Fever (infective process), weakness (dehydration)
Causes
-Do you eat spicy foods or drink coffee?
-Hx of prolonged use of steroids or NSAIDs? (PUD)
-Hx of prolonged fasting?
-Any hx of burns or head injury (r/o curlings ulcer & cushing’s ulcer)
-Hx of abdominal trauma
-Hx of ingestion of corrosive substances
-Do you drink alcohol or smoke cigarettes?
-Hx of fever, diarrhea, headache with ass abd pain (r/o typhoid enteritis
-Hx of easy fatiguability, poor appetite, early satiety with weight loss (r/o Gastric ca)
-Hx of yellowness of eyes, itching with abd swelling (r/o CLD)
-Hx of eating smoked foods or fish (r/o Gastric ca)
-What is your blood group? O (DU) or AB (GU)
-Family hx of PUD or gastric cancer?
Complications
:
-Hx of vomiting blood and passage of dark tarry stool- melena (r/o Gl bleeding)
-Hx of weakness and dizziness (r/o anemia)
-Hx of poor appetite, early satiety, weight loss (r/o malignant transformation)
-Hx of belt like pain (r/o penetration)
-Hx of vomiting recently ingested foods with abdominal distension (r/o GOO- gastric outlet obstruction)
-Hx of sudden generalized abdominal pain that is constant with fever (r/o perforation/ peritonitis)
Care so far
What have you done at home?
Hospitals visited?
INV done?
Treatment received?
Past medical history
Family,social and drug history
- Past medical and surgical history:
Hx of similar condition in the past?
Hx of chronic illnesses like HEADS,P (Hypertension, epilepsy, asthma, diabetes, sickle cell disease, PUD)
Hx of previous hospital admission, blood transfusion and surgery? - Familv and social historv:
Hx of similar condition in family?
Family hx of HEAD
Do you drink alcohol or smoke cigarettes?
Do you use any recreational drugs? - Drug history:
Have you been on any long term medications?
Are you currently on any drugs?
Any drug allergies?
Review of systems: Head to toe
Head: Dizziness, loss of consciousness, seizures etc
Eyes: Blurry vision, double vision
Nose: Nose bleeds
Mouth: sores, gum bleeding
Neck: neck swelling, excessive heat or cold
Chest: chest pain, breathlessness, awareness of heart beat, cough etc
Abdomen: abd distension, abd pain etc
Pelvis: Penile discharge, painful urination, frequency, urgency etc
Skin: skin discoloration, itching etc
Upper limbs: limb weakness, bone pain, joint pain, joint swelling
Lower limbs: Leg swelling, difficulty walking etc
THANK YOU!!
