Taking a Gastrointestinal History

Taking a Gastrointestinal HistoryDr. J.A. CoetserDepartment of Internal MedicineCoetserJA @ufs.ac.za

Major symptomsAbdominal painAppetite and/or weight changePostprandial fullness or early satiationNausea and vomitingHeartburn and/or acid regurgitationWaterbrashDysphagiaOdynophagia DiarrhoeaConstipation

BloatingBleedingHaematemesisMelenaHaematocheziaJaundiceDark urine, pale stoolsPruritisLethargy FeverSOCRATES

SiteOnsetCharacterRadiationAlleviating factorsTimingExacerbating factorsSeverityActivity 1: Gastroesophageal reflux disease

GERDSite?

RETROSTERNALGERDOnset and timing

BENDING OVER AND LYING DOWN

GERDCharacter

BURNINGBITTER / SOUR FLUID IN MOUTHGERDRadiation

TO NECKGERDAlleviating factors

ANTACIDSGERDExacerbating factors

Activity 2: Peptic ulcer diseasePUDSite

EPIGASTRICPUDOnset and timing

MEALSGASTRIC ULCER = WORSENSDUODENAL ULCER = IMPROVESPUDCharacter

BURNINGDULLPUDRadiation

TO BACKPUDAlleviating factors

ANTACIDSPUDExacerbating factors

OFTEN SPICY FOOD, NSAIDsActivity 3: Bleeding from peptic ulcer disease

PUDRISK FACTORS?NSAIDsAlcoholSmokingH. pylori infectionStressPUDStool changes

MELENA

Vomitus

COFFEE-GROUND

PUDVomitus

RED BLOOD

Activity 4: Pancreatic disease

Pancreatic diseaseSite

EPIGASTRICPancreatic diseaseOnset and timing

PAIN WITH MEALSPancreatic diseaseCharacter

DULL, STEADYPancreatic diseaseRadiation

TO BACKPancreatic diseaseAlleviating factors

Pancreatic diseaseExacerbating factors

MEALSALCOHOLLYING DOWNActivity 5: Biliary disease

Biliary diseaseSite

EPIGASTRIUM = COMMON BILE DUCTRIGHT HYPOCHONDRIUM = CYSTIC DUCTBiliary diseaseOnset

ACUTE EPISODES OF RECURRING PAINBiliary diseaseCharacter

USUALLY SEVERE, CONSTANT, LASTS FOR HOURSCAN BE COLICKYBiliary diseaseRadiation

RIGHT SHOULDERActivity 6: Renal calculiRenal calculiSite

FLANKSRENAL ANGLERenal calculiOnset and timing

ACUTERenal calculCharacter

SEVERE, COLICKY PAINRenal calculiRadiation

GROIN

Renal calculAlleviating factors

ROLLING AROUND OFTEN IMPROVES PAINActivity 7: Bowel obstructionBowel obstructionSite and radiation

SMALL BOWEL = UMBILICUSLARGE BOWEL = NON-SPECIFICBowel obstructionOnset and timing

SMALL BOWEL CYCLE = 2-3 MINLARGE BOWEL CYCLE = 10-15 MINBowel obstructionCharacter

COLICKYBowel obstructionAlleviating factors

ROLLING AROUND OFTENIMPROVES PAINActivity 8: Lower GIT bleeding

Activity 9: JaundiceJaundice

JaundiceDark urine + pale stools = biliary obstruction

Activity 10: Questions to ask a patient with diarrhoeaHow many stools a day do you normally pass?What do the stools look like?Do you have to rush to the bathroom to have a bowel movement?Does eating have any effect on the diarrhoea?Have you been woken from sleep during the night by diarrhoea?Have you seen any bright-red blood in the stools or mucus or pus?Are you passing large volumes of stool every day?Are your stools pale, greasy, smelly and difficult to flush away?Have you had problems with leakage of stool?Have you lost weight?Have you had any abdominal pain or vomiting?Have you had treatment with antibiotics recently?Have you had any recent travel?Have you a personal history of inflammatory bowel disease or prior GIT surgery?Have you any history in the family of coeliac disease or inflammatory bowel disease?Have you had any problems with arthritis?Have you had recent fever, rigors, or chills?Activity 11: Taking a history when the patient complains of constipationActivity 12: Taking an alcohol historyAlcoholCAGE questionsCut downHave you ever felt you ought to cut down on your drinking?AnnoyedHave people annoyed you by criticizing your drinking?GuiltyHave you ever felt bad or guilty about your drinking?Eye openerHave you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover?

Alcohol1U of alcohol = 8g of alcohol1U roughly is equivalent toOne glass of wine200mL of beerOne shot of spiritsHow much alcohol do you have to take to develop liver cirrhosis?Males = 60-80g per day for 10 yearsFemales = 40-60g per day for 10 yearsAlcohol How many grams of alcohol in:

5% = 5g/100mLAlcohol How many grams of alcohol in:

13% = 13g/100mLANY QUESTIONS?