GI History Introductory
Post on 01-Nov-2014
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History Taking SkillsGastrointestinal
System Introductory Course, 2011-2012
Khaled Jadallah, MD
Learning Objectives
• Essentials for proper history taking
• Common GI symptoms
• Features of most common GI symptoms
Outline for the Interview
• The Opening – Chief Complaint(s) – History of Present Illness (HPI)
• Primary• Secondary (focused ROS): associated
symptoms• Tertiary (focused PMH)
• Review of Systems• Past Medical History
The other Pieces of the Puzzle
• Past medical history
• Surgical history
• Drug history
• Social/occupational history
• Family history
GI Symptoms
• Halitosis• Mouth sores• Water brash• Heartburn• Odynophagia/dysphagia• Globus• Anorexia• Nausea• Vomiting• Weight loss• Abdominal pain
• Abdominal bloating• Increase in abdominal girth• Early satiety• Postprandial fullness• “Indigestion”/dyspepsia• Diarrhea• Constipation• Tenesmus• Anal pain or pruritis• Proctalgia fugax• Jaundice
Signs of GI Diseases
• General manifestations
• Eye manifestations• Oral/dental
manifestations• Skin/mucous
membranes manifestations
• Cardiovascular• Pulmonary• Hematolgical• Endocrine• Renal/urinary• Musculoskeletal• Neurological
Caput Medusae
Describes the appearance of distended and engorged umbilical veins which are seen radiating from the umbilicus across the abdomen to join systemic veins.
• Where the dysphagia is felt ?
• When did it start ?
• Is it intermittent or persistent ?
• What precipitate it ? Solid or Liquid ? Hot or Cold ?
Nausea and Vomiting
• Nausea:– “feeling sick to my stomach”
• Vomiting:– Forceful expulsion of gastric content out of the stomach
• Regurgitation:– Raising of gastric or esophageal material out of the stomach
in the absence of nausea
Details needed-color-content-smell-estimated amount-relation to eating
Bowel Movement• Frequency:
Three times a day to two times a week
• Volume• Color and contents
Blood, dark, frothy, mucus, greasy
• Difficulty in straining/ painful defecation• Smell !!• Tenesmus
Abdominal Pain
• Visceral pain:– Originates from abdominal organsOriginates from abdominal organs– Poorly localizedPoorly localized– Near the midlineNear the midline
• Parietal pain:– Originates from parietal peritoneumOriginates from parietal peritoneum– More localized over the involved organMore localized over the involved organ
• Referred pain:– Well localizedWell localized– Distant to the site of original organDistant to the site of original organ
Abdominal Pain
• Visceral pain:– Originates from abdominal organs– Poorly localized– Near the midline
• Parietal pain:Parietal pain:– Originates from parietal peritoneumOriginates from parietal peritoneum– More localized over the involved organMore localized over the involved organ
• Referred pain:Referred pain:– Well localizedWell localized– Distant to the site of original organDistant to the site of original organ
Abdominal Pain
• Visceral pain:Visceral pain:– Originates from abdominal organsOriginates from abdominal organs– Poorly localizedPoorly localized– Near the midlineNear the midline
• Parietal pain:– Originates from parietal peritoneum– More localized over the involved organ
• Referred pain:Referred pain:– Well localizedWell localized– Distant to the site of original organDistant to the site of original organ
Abdominal Pain
• Visceral pain:Visceral pain:– Originates from abdominal organsOriginates from abdominal organs– Poorly localizedPoorly localized– Near the midlineNear the midline
• Parietal pain:Parietal pain:– Originates from parietal peritoneumOriginates from parietal peritoneum– More localized over the involved organMore localized over the involved organ
• Referred pain:– Well localized– Distant to the site of original organ
• Timing of the pain
– Acute or chronic– Gradual or sudden– When did it start– How long did it last– What is the pattern over the last 24 hours
• How severe is the pain ?
– Not that helpful in identifying the cause of pain.
– Cultural differences– Severity tend to diminish with age
• Quality of pain ?
– Colicky/Cramping : suggest pain related to peristalsis
– Heartburn: acid reflux
– Sharp / stabbing: pancreatic
– Dull / aching: non-specific
• What aggravates or relieves the pain ?
– Eating– Medications– Emotional factors– Posture or activity– Body functions: defecation, menstruation
or urination.
Take-Home PointsGeneral
• Be organized!!
• Begin each medical interview with a patient-centered approach
• Use open-ended questions initially
• Work hard to develop effective doctor-patient communication skills
Take-Home PointsGI System
• GI complaints can be vague and confusing• When confronted with a patient complaining
of abdominal pain, the provider must first rule out catastrophic causes of pain
• Do not let the location of abdominal pain affect the breadth of your history taking
• Remember! GI problems can manifest with extra-GI symptoms, and, extra-GI problems can manifest with GI symptoms
On-Line Resources
• http://www.qub.ac.uk/cskills/video%20resource/GI%20history.htm
• http://www.meddean.luc.edu/lumen/meded/MEDICINE/PULMONAR/PD/contents.htm
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