Gastrointestinal History Flashcards
Presenting complaint - enquiries
Pain
Abdominal distention
Nausea and vomiting
Dysphagia
Dyspepsia, hiatus hernia, peptic ulceration
History of gallstones or previous pancreatitis
Jaundice
Altered bowel habit (diarrhoea/constipation)
Blood loss (haematemesis or rectal bleeding)
Mucus in stools or per rectum
Appetite
Weight change
Continence
Foreign travel
Central pain
Unpaired structure
Peptic ulcer
SOCRATES
Site: Epigastric
Onset: Acute or Gradual, Remissions = weeks or months
Character: Gnawing
Radiation: Into the back
Associated symptoms: can lead to GI haemorrhage, perforation can lead to peritonitis
Timing: 0.5-3 hours
Exacerbating factors: irregular meals (hunger), smoking, alcohol, aspirin and NSAIDs
Alleviating factors: food, antacids, vomiting
Severity: mild to moderate
Acute cholecystitis
SOCRATES
Site: Epigastric or right hypochondriacal
Onset: constant, unpredictable frequency or periodicity
Character: stabbing, piercing
Radiation: right scapula or tip of right shoulder
Associated symptoms: vomiting, fevers, rigours
Timing: 3-24 hours
Exacerbating factors: sometimes food
Alleviating: pain relief by medication
Severity: severe
Acute pancreatitis
SOCRATES
Site: Epigastric
Onset: sudden or gradual
Character: piercing, stabbing, burning
Radiation: into the back, may develop peritonitis
Associated symptoms: nausea, vomiting, abdominal distention, shock
Timing: lasts more than 24 hours
Exacerbating factors: eating
Alleviating: sitting upright
Severity: very severe
Vomiting questions
How frequent?
What time of day?
Taste, colour, smell, quantity?
Haematemesis? Fresh blood or coffee ground?
Gastric outlet obstruction, acute gastritis, acute cholecystitis, acute pancreatitis, hepatitis
Dysphagia questions
Is it continuous or intermittent?
How long does it last for?
Where does the food stick?
Is it solids, liquids or both?
Does it occur between meals?
Do you suffer from acid reflux or dyspepsia?
Nocturnal coughing or dyspnoea?
Risk factors for oesophageal carcinoma - smoking, alcohol, obesity, diet lacking in fruit and vegetables
Jaundice
Colour of urine and stools (haemolytic vs obstructive)
History of gallstones?
Pain (pancreatic cancer felt in the back and worse lying down)
Fevers and rigours?
Itching?
Social history - alcohol, drugs, foreign travel (inc transfusions and tattooing abroad), unprotected sex
Altered bowel habit
How has the habit altered? Diarrhoea, constipation or both?
Frequency of stools?
Any associated abdominal discomfort or urgency?
Incontinence?
Appearance of stool? Consistency (formed or unformed?) Does it float? Associated blood, pus or mucus?
Associated vomiting?
Foreign travel?
Medications, including over the counter remedies?
Causes of rectal bleeding
Haemorrhoids - fresh red, separate from stool, generally painless
Carcinoma - may be associated with mucus
IBD - may be mixed with pus or mucus
Diverticular disease
Anal fissures - fresh red, severe anal pain during and after defaecation
Melena - severe bleeding from upper GI tract tends to be dark in colour and may contain clots
Abdominal distention
Loss of weight and/or appetite
Specific questions to ask to complete gastro HPC
Previous gastrointestinal problems, diagnoses and effectiveness of any treatment
Previous gastrointestinal or abdominal surgery
Gynaecological problems (pelvis to abdomen communication)
History of jaundice, anaemia, diabetes
Drug history
Gastrointestinal side effects: iron tablets, opiates, NSAIDs, antibiotics, anticoagulants, SSRIs
Social history
Alcohol
Smoking
Occupation
Diet
Recent foreign travel
