Flashcards in Gastrointestinal Deck (16):
What does a history for a peptic ulcer look like?
Site – epigastric
Onset – acute or gradual, possible remissions for weeks/months
Character – gnawing
Radiation – into the back
Associated symptoms – GI haemorrhage or perforation possible
Timing – lasts 0.5-3hrs
Exacerbating factors – irregular meals/hunger, smoking, aspirin + NSAIDs
How do you better identify the location of a peptic ulcer?
Gastric – worse when full, better when hungry (leading to weight loss)
Duodenal – worse when hungry, better during/after eating (may wake in night with pain)
What does the history of acute cholecystitis look like?
Site – epigastric or right hypochondrial
Onset – constant, unpredictable frequency
Character – stabbing, piercing
Radiation – right scapula or tip of right shoulder
Associated symptoms – vomiting, fever + rigors (though more typically with ascending cholangitis = Charcot's triad)
Timing – 3-24hrs
Exacerbating factors – sometimes food
What does the history of acute pancreatitis look like?
Site – epigastric
Onset – sudden or gradual
Character – piercing, stabling, burning
Radiation – to back, may develop generalised peritonitis with widespread tenderness
Associated symptoms – N+V, distension, shock
Timing – lasts more than 24hrs
Exacerbating factors – eating
Alleviating factors – sitting upright
How would you take a history for vomiting?
What time of day? After anything in particular?
Taste, colour, smell, quantity? (inspect in person if possible)
Associated symptoms? - cough, chest pain
How would you take a history for dysphagia?
Is it continuous or intermittent?
How long does it last for?
Where does the food stick?
Is it solids or liquids or both? What was the timeline for this?
Does it occur between meals? (may suggest globus hystericus)
Do you suffer from acid reflux/dyspepsia
Any nocturnal cough or dyspnoea?
Risk factors for oesophageal carcinoma? (smoking, alcohol, obesity, lack of fruit/veg)
What does the history of jaundice look like?
Duration and evolution?
Features - pain (radiation to back? shoulder? timings?), fever/rigors
Red flags - painless, weight/appetite loss
Recent illness/fever + in close contacts?
Liver - abdo/ankle swelling, bruising/bleeding, confusion
Gallstones - abdo pain, stool/urine changes, itch, steatorrhoea, Hx?
Associated features - joint pain/lethargy/hyperpigmentation (haemochromatosis)
Viral hep risk factors - IVDU, blood transfusion, tattoos, needle stick injury, unprotected sex, uncooked sea food, foreign travel
Specific PMH/FH - jaundice? haemolytic anaemias? autoimmune disorders? Cancers?
What do you ask when taking a history of someone with an altered bowel habit?
How has the habit altered - diarrhoea (define?), constipation, both?
Frequency? Constant/remitting? Previous episodes?
Triggers? ie gluten, ill contacts, animals, uncooked food, recent travel, recent Abx use or other medications, diet changes?
Associated symptoms -
discomfort (relieved with defecation?), bloating, urgency, incontinence, anal pain?
Appearance - consistency, volume, floating, blood, pus, mucous, smell?
Nausea/vomiting? Fever/weight + appetite loss? Malasie?
What does the history of a PR bleed look like?
Not haematuria/vaginal bleed?
Onset + evolution? Previous episodes?
Where - mixed, coating, dripping?
Character - colour, consistency, mucous, smell?
Alleviating/exacerbating - diet, constipation, standing/sitting, anal sex, foreign body?
Other symptoms - bowel habit change, abdo pain, pruritis ani, piles etc
Anticoags in DH?
What does a history of someone with abdominal distension look like?
Any change in weight else where? (if losing weight - sub acute bowel obstruction, ascites, ovarian cyst etc)
What do you ask when taking a history of someone who has lost weight and appetite?
How much weight loss over how long?
Any change to appetite or deliberate reduction in intake?
What else should you ask when taking a history of someone presenting with a GI problem?
Previous GI problems, diagnoses and treatment efficacy
Previous abdominal surgery
Recent admissions to hospital - Abx usage
History of jaundice, anaemia, DM
DH + A?
Many drugs have GI side effects... ie iron tablets, opiates, NSAIDs, Abx, anticoag, SSRIs etc
Alcohol, smoking, occupation, diet, recent foreign travel
Carcinomas, IBD, malabsorption syndromes, Gilbert's syndrome