taking a GI specific Hx

Question 1

first steps

Answer 1

WIPER

ask for PT name, DOB, occupation.

Question 2

16 signs and symptoms to ask about

Answer 2

1 - abdo pain or distension
2 - nausea
3 - vomiting
4 - haematemesis
5 - dysphagia
6 - heartburn/dyspepsia
7 - diarrhoea
8 - constipation/ change of bowel habit
9 - PR bleeding
10 - weight loss
11 - loss of appetite, lethargy
12 - jaundice
13 - yellow sclerae
14 - pale stools
15 - dark urine
16 - recurrent mouth ulcers

Question 3

5 areas to ask about after the sign/symptom screen

Answer 3

PMSH
FH - bowel cancer or disease
SH - home circumstances, travel. 
smoking and alcohol and drugs
past and current medications and allergies.

Question 4

additional things to ask if PT complains of abdominal pain

Answer 4

SOCRATES

• all the questions of a standard GI Hx.
• systemically unwell? fever or night sweats
• have they eaten anything unusual or undercooked? how does the rest of the family feel?
• any urinary problems? haematuria or dysuria.
• time of last period and possibility of pregnancy.
• regular NSAIDS?

Question 5

additional things to ask if PT complains of dysphagia

Answer 5

all the questions of a standard GI Hx.

• time course
• pain?
• where does food get stuck
• liquids and solids?
• does it ease after a few swallows
• any regurgitation
• heartburn
• neck lumps
• cough, SOB, hoarse voice
• antibiotics been taken lately

Question 6

additional things to ask if PT complains of dyspepsia

Answer 6

all the q of a normal GI Hx

• SOCRATES
• describe the sensation of indigestion ( you may find its not dysphagia at all)
• bending over aggrivates
• bitter or acidic taste in mouth
• early satiety? (gastric cancer)
• bloating after meals? (IBS)

Question 7

additional things to ask if PT complains of vomiting

Answer 7

all the q of a normal GI hx
- SOCRATES
- related to abdo pain? relieves it?
- colour, volume, content, 
- systemically unwell
- eaten anything strange lately? family ok?
pregnant?

Question 8

additional things to ask if PT complains of vomiting

Answer 8

all the q of a normal GI hx

• SOCRATES
• pruritis
• bruise or bleed easy?
• foreign travel
• blood transfusion

Question 9

additional things to ask if PT complains of diarrhoea

Answer 9

all the q of a normal GI hx
- SOCRATES
- how often? what is normal for you?
- colour, structure, blood or mucus, foul smell, floaters,
- thyroid problems (diarrhoea is a symptom of thyrotoxicosis)
-

Question 10

additional things to ask if PT complains of constipation

Answer 10

all the q of a normal GI hx

• SOCRATES
• how often? what is normal for you?
• colour, blood, mucus, painful,
• straining, tenesmus

Question 11

additional things to ask if PT complains of rectal bleeding

Answer 11

all the q of a normal GI hx

• SOCRATES
• colour of blood
• blood- in stool, on stool, in bowl, on paper.
• mucus,
• pain
• hx of haemorrhoids
• feeling of dragging down on defecation
• normal passing urine