ToC History

Question 1

What are the common presentating symptoms re GIT?

Principle; These become associated features on history.

Answer 1

Abdominal Pain and Heartburn

• *Net fluids** - Diarrhoea, constipation, Nausea, Vomiting
• *Blood** - haematemesis, meleana
• *Nutritional Status** - Weight / Appetite/ Distension/ Dysphagia/ Satiation
• *Jaundice**/ puritis/ stools/ urine

Question 2

What are the characteristics of pain?

Answer 2

Site + Radiation

Character and Pattern

Frequency + Priors

Aggravating and Relieving Factors

How long does the pain take to go away?

Question 3

What are the aspects of site?

Answer 3

Quadrant - Where is the pain?

Radiation - Does it go anywhere?

Migration - Has it moved over time?

Point to it? Localisation by patient - localised

Maximum Intesity - Where is it the worst?

Question 4

Where can the pain radiate?

Answer 4

Radiation

PUD / Pancreatitis = radiates to the back
Diaphraghmatic irritation = shoulder
Oesophageal Spasm = throat

Question 5

What is the pain like?

Answer 5

Colicky - comes and goes

• Obstruction of bowel and ureters

Steady

Question 6

What some common A and Rs?

Answer 6

Do any of the following make the pain better or worse?

Eating - relief? precipitates ischaemic pain.

Posture - supine = worse in pacreatitis

Defacation - relief in colonic disease

Antacids - relief with PU pain

Movement - rolling = colic, still = peritonitis

Question 7

What is the pattern of PUD?

Answer 7

Dull and burning pain

Epigastrium

Reieved by foods/ antacids

Wake patient from sleep

Question 8

What are the patterns of Pancreatic Pain?

Answer 8

Constant pain radiates to the back

Worse supine

Relieved by sitting up and leaning forward

Vomitting common

Question 9

What are the patterns of billiary pain?

Answer 9

Epigastric pain

Severe, constant, last for hours

Cholecystitis - right sided pain (RUQ)

Question 10

Patterns of Renal Pain

Answer 10

Colicky pain on a background of cosntant pain

Radiation to groin

Really severe

Question 11

Patterns of Colonic Pain

Answer 11

Colicky pain

Small Bowel; cycle every 2-3 mins

Large Bowel obstruction; 10 - 15 mins

Associated; nausea, vomitting, constipation, distension

Question 12

What are some patterns of appetitie and weight change?

Answer 12

Weight loss + Anorexia = malignancy?

Weight loss + increased appetite = malabsorption/ hyperthyroidism

When did it occur? How much weight have you lost?

Question 13

Features of Satiation and Fullness

Answer 13

Satiation = inability to finish a meal

Fullness = dyspepsia

Question 14

What are some questions to consider re meals?

Answer 14

Satiation

Fullness

Appetite / Weight loss

Aggravated or relived by food

Question 15

Features of Nausea and Vomiting

Answer 15

Consider everything including ICP, bulaemia, contents

Vomitting + no nausea = colonic issue

Question 16

Heartburn and Acid Regurgitation

Answer 16

Heartburn; burning pain in retrosternal area, aggravated by bending/ supine. Relieved by antacids.

Acid Regurgitation; Sour fluid coming to mouth, triggers = coffee, fatty meal, Ca blockers

Question 17

Questions to ask re vomitting

Answer 17

1. What happens during an episode? (rules out rumination
2. How long has this been happening? (acute vs chronic)
3. Do you feel nauseous?
4. Before/ After/ During Meals
5. What does it look like? (bile/ blood/ feculent?)
6. Is there pain?
7. Hows your weight?
8. Medications?
9. Headache?

Question 18

GORD Questions

Answer 18

1. Frequency + Quality; Heartburn? more than once a week?
2. Context; After meals? supine?
3. Radiation; rule out MI
4. Relieved; antacids (acid reflux)
5. Do you suddendly taaste bitter fluid? (acid reflux)
6. salty fluid (waterbrash)
7. Trouble swallowing?
8. Cough when you lie down??