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Taking a Gastrointestinal History. Dr. J.A. Coetser Department of Internal Medicine CoetserJA @ ufs.ac.za. Major symptoms. Abdominal pain Appetite and/or weight change Postprandial fullness or early satiation Nausea and vomiting Heartburn and/or acid regurgitation Waterbrash

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Taking a Gastrointestinal History


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    1. Taking a Gastrointestinal History Dr. J.A. Coetser Department of Internal Medicine CoetserJA @ufs.ac.za

    2. Major symptoms Abdominal pain Appetite and/or weight change Postprandial fullness or early satiation Nausea and vomiting Heartburn and/or acid regurgitation Waterbrash Dysphagia Odynophagia Diarrhoea Constipation

    3. Bloating • Bleeding • Haematemesis • Melena • Haematochezia • Jaundice • Dark urine, pale stools • Pruritis • Lethargy • Fever

    4. SOCRATES • Site • Onset • Character • Radiation • Alleviating factors • Timing • Exacerbating factors • Severity

    5. Activity 1: Gastroesophageal reflux disease

    6. GERD Site? RETROSTERNAL

    7. GERD Onset and timing BENDING OVER AND LYING DOWN

    8. GERD Character BURNING BITTER / SOUR FLUID IN MOUTH

    9. GERD Radiation TO NECK

    10. GERD Alleviating factors ANTACIDS

    11. GERD Exacerbating factors

    12. Activity 2: Peptic ulcer disease

    13. PUD Site EPIGASTRIC

    14. PUD Onset and timing MEALS GASTRIC ULCER = WORSENS DUODENAL ULCER = IMPROVES

    15. PUD Character BURNING DULL

    16. PUD Radiation TO BACK

    17. PUD Alleviating factors ANTACIDS

    18. PUD Exacerbating factors OFTEN SPICY FOOD, NSAIDs

    19. Activity 3: Bleeding from peptic ulcer disease

    20. PUD • RISK FACTORS? • NSAIDs • Alcohol • Smoking • H. pylori infection • Stress

    21. PUD • Stool changes MELENA • Vomitus COFFEE-GROUND

    22. PUD Vomitus RED BLOOD

    23. Activity 4: Pancreatic disease

    24. Pancreatic disease Site EPIGASTRIC

    25. Pancreatic disease Onset and timing PAIN WITH MEALS

    26. Pancreatic disease Character DULL, STEADY

    27. Pancreatic disease Radiation TO BACK

    28. Pancreatic disease Alleviating factors

    29. Pancreatic disease Exacerbating factors MEALS ALCOHOL LYING DOWN

    30. Activity 5: Biliary disease

    31. Biliary disease Site EPIGASTRIUM = COMMON BILE DUCT RIGHT HYPOCHONDRIUM = CYSTIC DUCT

    32. Biliary disease Onset ACUTE EPISODES OF RECURRING PAIN

    33. Biliary disease Character USUALLY SEVERE, CONSTANT, LASTS FOR HOURS CAN BE COLICKY

    34. Biliary disease Radiation RIGHT SHOULDER

    35. Activity 6: Renal calculi

    36. Renal calculi Site FLANKS RENAL ANGLE

    37. Renal calculi Onset and timing ACUTE

    38. Renal calcul Character SEVERE, COLICKY PAIN

    39. Renal calculi Radiation GROIN

    40. Renal calcul Alleviating factors ROLLING AROUND OFTEN IMPROVES PAIN

    41. Activity 7: Bowel obstruction

    42. Bowel obstruction Site and radiation SMALL BOWEL = UMBILICUS LARGE BOWEL = NON-SPECIFIC