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MD3002 Week 1 > 3. History Taking- Abdomen and GU > Flashcards

3. History Taking- Abdomen and GU Flashcards

1
Q

What are the systems enquiry questions for the HPC GI?

A
  • Abdominal pain
  • Anorexia and weight change
  • Dyspepsia / Indigestion
  • Dysphagia
  • Nausea and vomiting
  • GI tract bleeding
  • Jaundice
  • Change in bowel habit – constipation / diarrhoea

Always remember RED FLAGS

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2
Q

What are the systems enquiry questions for the HPC of GU?

A
  • Dysuria – pain / burning passing urine
  • Urinary frequency – need to go more often
  • Urgency – need to go NOW
  • Hesitancy – want to go, but it won’t start
  • Nocturia- passing urine at night
  • Urinary flow - strength of urinary stream (mainly men)
  • Incontinence – stress or urge or mixed
  • Haematuria – blood in urine. Can be microscopic or macroscopic
  • Loin pain - Pain at the side of the back , below the ribs
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3
Q

What are the questions to ask regarding pain?

A

Socrates

  1. Site
  2. Onset
  3. Character
  4. Radiation
  5. Associated symptoms
  6. Timing
  7. Exacerbators/relievers 8. Severity
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4
Q

What are the names of the 9 regions for identifying pain?

A 
Right hypochondrium
Epigastric region
L hypochondrium
R flask
Umbilical region
L flank
R iliac fossa 
Hypogastric/ suprapubic region
L iliac fossa
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5
Q

What are the names of the 4 quadrants?

A

Right upper quadrant
Left upper quadrant
Right lower quadrant
Left lower quadrant

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6
Q

What condition do the following pain radiations suggest:
– Radiation to the back
– Shoulder tip
– Radiation from loin to groin

A

– Radiation to the back – pancreatitis
– Shoulder tip- diaphragmatic irritation
– Radiation from loin to groin- renal colic (kidney stone)

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7
Q

What re 5 associated symptoms to GI pain?

A 
– Sweating / Fevers
– Vomiting /nausea
– Diarrhoea
– Urinary symptoms
– Vaginal bleeding / discharge

WEIGHT LOSS **

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8
Q

Name 5 common exacerbates and receivers for GI pain?

A 
Common exacerbating factors:
– Eating/noteating
– Movement/ lack off
– Position
– Exercise(thinkcardiacdisease) 
– Urination/menstruation
Common relieving factors: 
– Eating/noteating
– Vomiting/openingbowels
– Movement/lackofmovement
– Position
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9
Q

4 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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10
Q

5 causes for unexplained weight loss

A

– Malignancy
– Malabsorption e.g. chronic pancreatitis / coeliac disease / Crohn’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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11
Q

Dyspepsia?

A

Indigestion

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12
Q

Symptoms of dyspepsia?

A

Heartburn, acidity, pain, discomfort, nausea, wind, fullness or belching

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13
Q

What is dyspahgia?

A

Sensation of obstruction during passage of liquid or solid
food through pharynx or oesophagus

Can be confused with globus

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14
Q 
Causes of dysphagia:
Oral (2)
Neurological (2)
Neuromuscular (4)
Mechanical (5)
A

Oral:
Painful mouth ulcers
Tonsillitis / pharyngitis / glandular fever

Neurological:
CVA
Bulbar or pseudobulbar palsy

Neuromuscular:
Achalasia
Pharyngeal pouch Myasthenia Gravis
Diffuse oesophageal spasm

Mechanical:
Oesophageal carcinoma
Peptic oesophagitis
Benign stricture
Extrinsic compression (e.g. lung tumour, lymph nodes, goitre)
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15
Q

What is haematemesis?

Causes?

A

Vomiting blood - fresh red or “coffee-ground)

Causes: Gastric/duodenal ulcer, gastric erosions, varices

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16
Q

Sign and cause for upper GI bleeding?

A

Malaena: Passage of black tarry stools.

Usually secondary to bleed in oesophagus, stomach or duodenum. Caused by peptide ulceration

17
Q

Sign and cause of lower GI bleeding?
Questions to ask?
Associated symptoms?

A

Fresh red blood

Questions to ask:
– Duration and frequency? / Is it mixed with stool? / associated symptoms?

Associated symptoms:
– E.g. Diarrhoea, constipation, abdominal pain, change in bowel
habit, weight loss, rectal / anal pain

Causes:
– Haemorrhoids / anal fissure / diverticular disease / large bowel polyps or carcinoma / inflammatory bowel disease

18
Q 
Jaundice:
What is it?
Causes?
Questions to ask?
Painless jaundice suggests..
A

Jaundice: Yellow discolouration of sclerae/skin

Causes: Pre-hepatic/ hepatic/ post-hepatic

Questions to ask:

  • Duration?
  • Associated symptoms?
  • Colour of stool and urine
  • Travel
  • Consumption of shellfish
  • Blood transfusion
  • Alcohol consumption
  • Changes in medications
  • Unprotected sex

Painless jaundice suggests carcinoma of head of pancreas

19
Q

Common causes of constipation?

A 
Diet/dehydration
Painful anal conditions 
Immobility
Medication e.g. opiates
Hypothyroidism 
Colonic / rectal carcinoma 
Neuromuscular e.g. spinal cord disease / Parkinson's disease
Hypercalcaemia 
IBS
20
Q

Common causes of diarrhoea

A

– Diet
– Stress
– Infection e.g. viral gastroenteritis / food poisoning
– Inflammation e.g. ulcerative colitis / Crohn’s
– Endocrine e.g. hyperthyroidism
– Malabsorption e.g. coeliac disease / pancreatic disease
– Medication
– Irritable bowel syndrome

21
Q

10 Upper GI 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 dyspepsia without other symptoms if >55 yrs old
  • New onset upper GI pain if >55yrs old OR if risk factor (e.g.+ve FH)
22
Q

7 lower GI tract red flags?

A 
Repeated rectal bleeding 
Blood mixed with stool
Persistent change in bowel habit 
Right sided abdominal mass
Palpable rectal mass
Unexplained iron deficiency anaemia 
Past history of lower GI cancer plus any of above
23
Q

What is the difference in the presentation of a lower UTI and and upper?

A

Lower UTI = Cystitis (bladder inflammation)
Symptoms: Dysuria, frequent urination, urgent, suprapubic discomfort, possible haematuria

Upper UTI = Pyelonephritis (kidney inflammation)
Symptoms: Loin pain, fevers, riggers, flank tenderness, urinary frequency, dysuria, possible haematuria

24
Q

What is prostatism?

A

Symptoms of prostate enlargement:

  • Irritative: Urgency/dysuria/ frequency/ nocturia
  • Obstructive: Reduced force of stream / hesitancy
  • Prostatitis can cause perineal pain
25
Q

Causes for loin pain?

A 
Pyelonephritis 
Renal calculi (loin to groin) Hydronephrosis 
Renal tumour 
Renal abscess 
Referred pain from back
26
Q

Causes of haematuria

A 
UTI
Urinary tract calculi
Bladder carcinoma
Glomerulonephritis
Renal carcinoma
Benign prostatic hypertrophy
Prostatic carcinoma
27
Q

Which type of haematuria much be investigated further

A

Macroscopic

Persistent microscopic

28
Q

What are the GU red flags

A
  • Any age with painless macroscopic haematuria
  • Haematuria and symptoms of UTI but sterile urine
  • Testicular swelling
  • Abdominal mass from urinary/genital tract
  • Hard irregular prostate
  • Normal prostate, but rising / raised age specific PSA (prostate specific antigen) with or without lower urinary tract symptoms
  • Symptoms and high PSA levels
  • Postmenopausal bleeding
  • Persistent intermenstrual bleeding
  • Palpable pelvic mass/cervical lesion/vulval mass

MD3002 Week 1 (10 decks)

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