Screening the GI system

Question 1

Upper GI system checklist

Answer 1

Swallowing difficulties
• Indigestion, heartburn
• Food intolerance
• Bowel dysfunction

Question 2

Lower GI checklist

Answer 2

• Color of stool
• Shape, caliber of stool
• Constipation
• Diarrhea
• Difficulty initiating
• Incontinence

Question 3

Potential causes of dysphasia

Answer 3

Muscle Incoordination

• myasthenia gravis
• multiple sclerosis
• ALS
• Parkinson’s

Mechanical Obstruction

• neoplasms
• goiter of thyroid gland
• C-spine osteophytes
• aortic aneurysm

Question 4

Possible causes of indigestion, heartburn, dyspepsia

Answer 4

• GERD
• Peptic ulcer
• NSAID use
• insidious onset

Question 5

Questions to ask about indigestion, heartburn, dyspepsia

Answer 5

• How long have you had these symptoms?
• Do you know what is causing them?
• Are they constant or intermittent?
• How are you treating the symptoms?
• Any associated symptoms (e.g., fatigue, weakness, shortness of breath)?

Question 6

Patient self management for indigestion, heartburn, dyspepsia

Answer 6

 Antacids: Milk of Magnesia, Tums, Maalox
 Histamine (H2) Antagonists: Tagamet, Zantac, Pepcid AC
 Dietary modification

Question 7

Common irritants/triggers for food intolerance

Answer 7

 Cheeses
 Chocolate
 Citrus fruits
 Nuts
 Red Wine

Question 8

Upper GI system: Bowel dysfunction/melena

Answer 8

• Passage of black, tarry stools

• GI bleeding, probably upper GI in origin
• Esophagus
• Stomach
• Duodenum

• Follow-up questions:
• How long have you been having black, tarry stools?
• Have you felt lightheaded?
• Any nausea, vomiting, diarrhea, fatigue, lightheadedness, abdominal/back pain, or sweats
associated with these stools?

• Check HR and BP

Question 9

Lower GI system: Bowel dysfunction

Answer 9

Indicators of Possible Issues
 Color of stool
 Shape, caliber of stool
 Constipation
 Diarrhea
 Difficulty initiating
 Incontinence 

Screening Questions
“Have you recently noticed any problems or difficulties with bowel function?”
“Noticed any changes in bowel habits? Frequency? Type?”

Question 10

Potential causes of constipation

Answer 10

Impaired mobility

• inadequate dietary fiber
• inactivity
• diverticulitis
• hypothyroidism
• hypercalcemia
• scleroderma

Neurologic dysfunction

• MS
• SC injury

Psychosocial dysfunction

• depression
• situational stress
• anxiety

Question 11

Diarrhea potential causes

Answer 11

infectious agents
laxative abuse
colon cancer
IBS
crohn's disease
ulcerative colitis
diabetic enteropathy

Question 12

Screening questions for constipation and diarrhea

Answer 12

 How long have you been constipated?
 When was the last time you had a bowel movement?
 Do you ever have periods of constipation alternating with periods of
diarrhea (a pattern noted in some patients with colon cancer or
diverticulitis)?
 Do you have any associated symptoms, such as malaise, a sensation of
abdominal fullness or bloating, fever, agitation, or altered mental status?
 Recent changes in diet or fluid intake?
 Medication changes?

Question 13

Dehyrdration due to diarrhea follow up questions

Answer 13

 How many episodes do you have each day?
 How long have you had diarrhea?
 Do you ever have periods of diarrhea alternating with periods of constipation?
 Is the diarrhea worse at certain times of the day?
 Do family members or companions have similar symptoms?
 Do you have any associated symptoms, such as fever, chills, nausea, vomiting,
confusion, or abdominal pain or distention?

Question 14

Possible manifestations of dehydration

Answer 14

rapid breathing
confusion
postural hypotension
rapid pulse ( <100bpm)
irritability
dizziness
headache
increased thirst
skin turgor
capillary refill
darker urine color
dry mouth

Question 15

Low GI: Hematochezia

Answer 15

passage of bright blood-red stools

origin: left side of the colon or anorectal area

Question 16

screening questions for hematochezia

Answer 16

 How long have you noticed bright red blood in your stools?
 Is the red blood mixed within the stools (red streaks) or not?
 Are there any associated symptoms, such as difficulty in initiating bowel
movements or a feeling of lightheadedness or fatigue?

Question 17

Colon carcinoma

Answer 17

malignancy in large intestine

origin: polyps in colon (upper) or rectum (lower)

screening questions
 Any unusual shape in stool, pencil-like in diameter or flat, ribbon-like?
 Any blood in your stool, when you go to the bathroom?

Question 18

possible symptoms of colon carcinoma

Answer 18

change in bowel habits
blood in toilet
weakness
constipation
diarrhea
fatigue
rectal bleeding
abdominal pain, cramps, gas
unexplained weight loss