GI and GU history taking

Question 1

how do you ask about pain

Answer 1

scale on 1- 10 
stops you sleeping
writhing
ask patient to show you and watch hands
socrates
does it stop you doing anything 
sharp/dull/throbbing etc

Question 2

what is renal colic

Answer 2

pain from kidney stones

pain in loin and groin

Question 3

what could shoulder tip pain indicate

Answer 3

irritation of the diaphragm

gallstones

Question 4

what could pain radiating to the back indicate

Answer 4

pancreatitis

Question 5

what does Socrates stand for

Answer 5

Site
Onset
Character 
Radiation
Associations 
Time 
Exacerbating/Relieving factors
Severity

Question 6

what associated symptoms might be present

Answer 6

nausea/ vomiting
diarrhea
vaginal bleeding and discharge
sweating/ fever 
urinary symptoms  
weight loss/gain

Question 7

what questions can you ask about diet

Answer 7

has your appetite changed
are your clothes looser? 
have you been trying to lose weight 
have you lost weight? 
do you still enjoy food

Question 8

what could be possible causes of weight loss

Answer 8

malignancy
malabsorption 
metabolic diseases 
psychiatric 
malnutrition

Question 9

what could cause weight gain

Answer 9

fluid gain eg due to heart failure
hypothyroidism
depression

Question 10

what could cause fluid gain

Answer 10

heart failure
nephrotic syndrome
liver disease

Question 11

what are the symptoms of dyspepsia

Answer 11

heart burn, wind, belching, vomiting, discomfort, fullness, bloating

Question 12

what is globus sensation

Answer 12

the feeling of something in your throat

Question 13

what are the neuro causes of dysphagia

Answer 13

CVA

bulbar or psuedobulbar palsy

Question 14

what are the neuromuscular causes of dysphagia

Answer 14

Achalasia
Pharyngeal pouch
Myasthenia Gravis
Diffuse oesophageal spasm

Question 15

what are the mechanical causes of dysphagia

Answer 15

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

Question 16

what are the oral causes of dysphagia

Answer 16

Painful mouth ulcers

Tonsillitis / pharyngitis / glandular fever

Question 17

what questions can you ask about dysphagia

Answer 17

solids/ liquids
where is the obstruction 
intermittent?
associated symptoms 
pain 
regurgitation

Question 18

what questions can you ask about nausea and vomiting

Answer 18

pain, diarrhea, constipation 
changes to medication 
pregnancy or possible pregnancy 
frequency and duration 
vomitus- food/ blood/ bile

Question 19

what could cause haematemesis

Answer 19

– Gastric or duodenal ulcer 
 gastric erosions
varices 
Mallory-Weiss syndrome 
 Reflux oesophagitis 
 gastric carcinoma

Question 20

what is the most common cause of severe and life threatening GI bleeding

Answer 20

peptic ulcers

Question 21

what does melaena indicate

Answer 21

black tarry stools
bleeding in the oesophagus, duodenum or stomach but may be further down
most commonly caused by chronic peptic ulceration

Question 22

what questions can you ask about blood in the stool

Answer 22

is it on the surface or mixed in?
duration and frequency
associated symptoms

Question 23

what symptoms may be associated with blood in stool

Answer 23

diarrhoea, constipation, abdo pain, change in bowel habit, weight loss, rectal/ anal pain

Question 24

what may cause blood in stools

Answer 24

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

Question 25

what is pre hepatic jaundice

Answer 25

a condition or infection speeds up the breakdown of red blood cells. This causes bilirubin levels in the blood to increase

Question 26

what is hepatic jaundice

Answer 26

a problem in the liver affects its ability to process bilirubin

Question 27

what is post hepatic jaundice

Answer 27

the bile duct system is damaged, inflamed or obstructed, which results in the gallbladder being unable to move bile into the digestive system.

Question 28

what questions can you ask about bowel habit

Answer 28

Duration – Colour of stool – mucous / fresh or altered blood – Constipation / diarrhoea, or mixture of both – Associated symptoms e.g. pain / nausea or vomiting / weight loss / appetite / tenesmus (feeling of not fully emptying bowels) – Changes in diet or medication / other illnesses

Question 29

what topics should be covered in a GI systems inquiry

Answer 29

``` abdo pain anorexia weight loss dyspepsia dysphagia nausea and emesis bleeding jaundice bowel habit ```

Question 30

what topics should be covered in a GU systems inquiry

Answer 30

``` urinary frequency dysuria nocturia incontinence hesitancy urgency flow haematuria ( may macro/microscopic) pain frequency ```

Question 31

what GU questions can women be asked

Answer 31

``` vaginal bleeding discharge menstrual history obstetric history (pregnancies and births) sexually active contraception last menstrual period ectopic pregnancy STI surgeries pelvic pain ```

Question 32

what types of malabsorption might cause weight loss

Answer 32

pancreatitis coeliac disease crohn's disease

Question 33

what types of metabolic disease might cause weight loss

Answer 33

diabetes hyperthyroidism renal disease chronic infection

Question 34

what questions should be asked if a patient presents with jaundice

Answer 34

``` duration pain weight loss fevers colour of stool and urine travel shellfish consumption blood transfusion alcohol consumption medication IV drug use unprotected sex ```

Question 35

what does painless jaundice indicate

Answer 35

carcinoma of head of pancreas

Question 36

what does tenesmus mean

Answer 36

the feeling of not fully emptying one's bowels

Question 37

what can cause constipation

Answer 37

``` diet dehydration anal fissure or similar immobility medication e.g. opiates hypothyroidism colonic/ rectal carcinoma neuromuscular e.g. Parkinson's or MS hypercalcaemia which may be related to malignancy ```

Question 38

what may cause diarrhoea

Answer 38

``` diet stress infection inflammation endocrine eg. hyperthyroidism malabsorption e.g. coeliac/ pancreatic disease medication chronic overflow ```

Question 39

what are some upper GI red flags

Answer 39

``` evidence of blood loss weight loss pain or mass painless jaundice persistent vomiting iron deficiency anaemia worsening dyspepsia ```

Question 40

what are some lower GI red flags

Answer 40

* >= 40 yrs old with rectal bleeding and change of bowel habit * >=60 yrs old with rectal bleeding for 6 weeks or more without a change in bowel habit and no anal symptoms * >=60 yrs old with a change in bowel habit to looser stools and / or more frequent stool for 6 weeks or more without rectal bleeding * Of any age with right lower abdominal mass consistent with involvement of large bowel * Of any age with palpable rectal mass * Unexplained iron deficiency anaemia

Question 41

what symptoms are associated with a lower UTI aka cystitis or bladder infection

Answer 41

``` dysuria frequency urgency suprapubic discomfort haematuria ```

Question 42

what symptoms are associated with an upper UTI aka pyelonephritis or kidney infection

Answer 42

``` loin pain fevers rigors flank tenderness urinary frequency dysuria haematuria ```

Question 43

what are the symptoms of prostatism

Answer 43

irritative- urgency, dysuria, frequency, nocturia obstructive- reduced force of urine flow, hesitancy, interruption of stream perineal pain

Question 44

what may cause haematuria

Answer 44

uti, calculi, carcinoma of bladder, kidney or prostate, glomerulonephritis, BPH, bleeding disorders or anticoagulants

Question 45

what are GU red flags

Answer 45

* Any age with painless macroscopic haematuria * >=40 with recurrent or persistent UTI associated with haematuria * >=50 with unexplained microscopic haematuria * Abdominal mass thought to be from urinary tract * Hard irregular prostate * Normal prostate, but rising / raised age specific PSA with or without lower urinary tract symptoms * Symptoms and high PSA levels

Question 46

what is mallory weiss syndrome

Answer 46

gastro-esophageal laceration syndrome caused by vomiting and causes haematemesis