Block 3 - GIT Flashcards
What are 10 common GIT complaints?
- Abdominal pain
- Change in appetite
- Unintentional weight gain or loss
- Nausea or vomiting
- Indigestion/heartburn
- Dysphagia (difficulty in swallowing)
- Change in bowel motions
- Haematemesis (vomiting blood)
- Jaundice (yellowish tinge to eyes and skin)
- Pain on distension
14 Red flags in acute abdominal pain?
Gastrointestinal History Protocol? (8)
Gastrointestinal History Protocol
1. Introduction
2. Presenting Symptoms & HxPC
3. Past Medical History
4. Treatment/Medications
5. Allergies
6. Social History
7. Family History
8. ROS
What questions should you ask about a patient’s past medical history in a Gastrointestinal History? (5)
GIT History - Past Medical History
1. Previous episodes of the same?
2. Surgical history?
3. Inflammatory bowel disease?
4. Gastro-oesophageal reflux?
5. Any history of endoscopy, colonoscopy - reason, results?
What questions should you ask about a patient’s medications/treatments in a Gastrointestinal History? (5)
GIT History - Treatment/Medications
1. Prescribed?
2. OTC?
3. Herbal?
4. NSAIDs - possible pain/bleeding?
5. Drugs affecting the liver - steroids? alcohol? paracetamol?
What questions should you ask about a patient’s social history in a Gastrointestinal History? (6)
GIT History - Social History
1. Occupation
2. Recent travel
3. Smoking
4. Alcohol
5. Illicit drugs
6. Risk factors for blood-borne diseases, particularly Hepatitis C – sexual history, tattoos, shared needles, known contacts
What questions should you ask about a patient’s family history in a Gastrointestinal History? (7)
GIT History - Family History
1. GI malignancy (age of onset)
2. Inflammatory bowel disease
3. Autoimmune disease
4. Jaundice
5. Anaemia
6. Splenectomy
7. Cholecystectomy
Which specific questions should you ask for a patient presenting with abdominal pain? (7)
Abdominal Pain: SOCRATES
1. Elicit pain history including frequency and duration: Acute or chronic
2. When and how often
3. Site – ask patient to point to site.
4. Radiation
5. Pattern of pain: colicky or constant
6. Aggravating and relieving factors.
7. Associated symptoms - bowels & urine? vomit? women - periods? sexual activity?
6 Common causes of unintentional weight loss?
** GIT History - Unintentional weight gain or loss**
1. Malabsorption
2. Malignancy
3. Thyroid disease
4. Inflammatory bowel disease
5. Eating disorders
6. Depression
6 Common causes of unintentional weight loss?
** GIT History - Unintentional weight gain or loss**
1. Malabsorption
2. Malignancy
3. Thyroid disease
4. Inflammatory bowel disease
5. Eating disorders
6. Depression
11 QUESTIONS TO ASK A PATIENT PRESENTING WITH RECURRENT VOMITING?
**GIT History **
Nausea and/or vomiting: timing, frequency, aggravating and relieving factors
8 QUESTIONS TO ASK THE PATIENT WITH ACID REFLUX OR SUSPECTED GASTRO-OESOPHAGEAL REFLUX DISEASE (GORD)?
9 QUESTIONS TO ASK A PATIENT WHO
REPORTS DIFFICULTY SWALLOWING (DYSPHAGIA)?
Differentials for Dysphagia?
17 QUESTIONS TO ASK THE PATIENT PRESENTING WITH DIARRHOEA?
13 QUESTIONS TO ASK A PATIENT
PRESENTING WITH CONSTIPATION?
7 QUESTIONS TO ASK THE PATIENT WHO PRESENTS WITH VOMITING BLOOD (HAEMATEMESIS)?
19 QUESTIONS TO ASK THE PATIENT PRESENTING WITH JAUNDICE?
Jaundice, dark urine, pale stools, pruritis?
Gastrointestinal Exam Protocol? (10)
Gastrointestinal Exam Protocol
1. Introduction
2. Exposure and Positioning
3. General Inspection
4. Hands - Nails, Palms, Asterixis
5. Arms
6. Face - Eyes, Salivary glands, Mouth
7. Neck & Chest - Inspection, Palpation
8. Abdomen - IPPA
9. Groin
10. Other - Rectal examination, vital signs, urinalysis
GIT Exam - Introduction? (4)
GIT Exam - Introduction
1. Introduces Self
2. Washes hands
3. Explains procedure & gains consent
4. Confirms name & age
“Hi my name is Kitty and i’m a second year medical student. I’ve been asked to come and examine you for any possible gastrointestinal problems. This will involve me having a look at your hands, arms, face, neck and chest then a quick look, listen and feel of your adbomen. Does this all sound ok? Before we get started please can I confirm your name and age? Are you in any pain or is there anything I can get to make you more comfortable?”
GIT Exam - Exposure and Positioning?
GIT Exam - Exposure and Positioning
Lying flat with head on one pillow, expose chest and abdomen
GIT Exam - General Inspection? (6)
GIT Exam - General Inspection
1. Jaundice - hyperbilirubinaemia (prehepatic/hepatic/post-hepatic= obstructive)
2. Body habitus – weight
3. Cachexia/wasting = malabsorption/malignancy/ alcoholic cirrhosis
4. Skin lesions - pigmentation - haemochromatosis, acanthosis nigricans
5. Mental state
6. Vomitus bags or stool sample pots
GIT Exam - Hands? (6)
GIT Exam - Hands
1. Leuconychia = hypoalbuminaemia (chronic liver disease)
2. Clubbing = cirrhosis
3. Palmar Erythema = chronic liver disease
4. Palmar crease pallor - anaemia (GIT bleed, malabsorption)
5. Dupytren’s contracture = permanent flexion = alcoholism BUT not specific
6. Asterixis - liver flap
GIT Exam - Arms? (5)
GIT Exam - Arms
1. Bruising, petechiae = hepatic disease and reduced clotting factor production
2. Muscle wasting
3. Scratch marks = excoriations = obstructive or cholestatic jaundice
4. Spider naevi = alcoholic cirhhosis, viral hepatitis, pregnancy (estrogen excess)
5. Axillary lymphadenopathy
