GI history

Question 1

Organs involved.

Answer 1

GI tract.

• Mouth, lips, tongue
• Pharynx
• Oesophagus
• Stomach
• Small intestine
• Large intestine
• Appendix
• Rectum
• Anus

Biliary tree.

• Pancreas
• Liver
• Gallbladder
• Bile ducts

Other.

• Spleen
• Kidneys
• Adrenal glands
• Reproductive organs (ovaries, testes, etc.)

Question 2

Layers involved in abdominal wall.

superficial to deep

Answer 2

• Skin
• Subcutaneous tissue
• Camper’s fascia - fatty superficial layer (fatty Camper)
• Scarpa’s fascia - deep fibrous layer (skinny Scarpa)
• External oblique abdominal muscle.
• Internal oblique abdominal muscle.
• Rectus abdominis.
• Transversalis fascia.
• Extraperitoneal fat.
• Parietal peritoneum.
• Visceral peritoneum
• Viscera

Question 3

GI symptoms.

a) Upper GI symptoms
b) Lower GI symptoms
c) Biliary symptoms
d) Systemic symptoms
e) In women, also ask what?

Answer 3

a) - Oral lesions
- Dysphagia
- Heartburn, reflux, regurgitation
- Dyspepsia
- Abdominal pain/ discomfort/ fullness
- Nausea and vomiting

b) - Constipation
- Diarrhoea
- Abdominal pain
- Abdominal distension
- Rectal bleeding, mucus (slime)
- Stool colour change (eg. melaena, steatorrhoea)
- Tenesmus
- Painful defecation (dyschezia)
- Incontinence

c) - Jaundice
- Pale stools, dark urine, pruritis
- Liver disease: ascites, chronic stigmata, etc.

d) - Fever, rigors, etc.
- Weight loss and loss of appetite

e) Last menstrual period (LMP)

Question 4

Relevant PMHx.

a) Medical
b) Surgical

Answer 4

a) - IBD
- Liver disease
- Gallstones

b) - Previous surgery (?adhesions)
Relevant FHx.
- IBD
- Malignancy

Question 5

Relevant DHx.

Answer 5

• ALLERGIES (always important)
• Hepatotoxic drugs (hepatitis)
• P450 enzyme inducers
• Opiates (constipation, stercoral perforation)
• Iron (melaena)
• Prokinetics, eg. erythromycin, metoclopramide (diarrhoea)
• NSAIDs /aspirin (gastritis, PUD)

Question 6

Relevant SHx.

a) General
b) Particularly for jaundice

Answer 6

a) - Alcohol intake
- Smoking
- Travel history
- Dietary changes

b) - IVDU
- Sex history

Question 7

Non-GI differentials.

a) Abdo pain
b) Jaundice
c) Diarrhoea
d) Constipation

Answer 7

a) - DKA
- Aortic aneurysm
- Urinary pathology

b) - Haemolytic conditions

d) - Hypercalcaemia
- Hypokalaemia
- Hypothyroidism