Gastrointestinal History

Presenting Complaint

Abdominal pain
1.  Site/radiation Ask the patient to point to the site of pain

• Pancreatitis → Back
• Epigastric – oesophagitis, gastritis, peptic ulcer disease, pancreatitis
• Right Upper Quadrant – gallstones, cholangitis, cholecystitis
• Central Abdominal – irritable bowel syndrome, inflammatory bowel disease
• Suprapubic – diverticular disease, irritable bowel syndrome, inflammatory bowel disease
• Flank – renal colic
• Right Iliac Fossa – appendicitis, hernia, ovarian cyst

2. radiation of pain

• Appendicitis pain commonly begins in the periumbilical region, later radiating to and then localising in the RIF
• Pancreatitis pain can radiate from the epigastric region through to the back
• Gall bladder pain can radiate around into the flank and the back
• Renal pain can radiate down along the ureters and into the groin
• Pain associated with subdiaphragmatic irritation (gall stones, perforated ulcer) can also be felt in the right shoulder and tip of the scapula.

3.  Onset/periodicity/duration

• Onset - When did the pain start? Sudden or gradual
• Periodicity - How often it occurs
• Duration – “How long does / did it last?”
• Acute/chronic

4.  Character and severity
Sharp/burning/dull/gnawing
Colicky pain comes in waves e.g. from obstruction of bowel

5.  Associated features

• Loss of appetite/weight -Ask about any change in appetite. Determine from patient how much weight loss has occurred, and over what period, i.e. 2 kg over two months
• Nausea and vomiting

Acute - gastrointestinal infection e.g. Food poisoning [staphylococcus aureus]
Ask about contents – old food e.g. Gastric outlet obstruction
Blood [haematemesis] – gastric/oesophageal - ulceration/malignancy

Other causes

• Small bowel obstruction
• Pregnancy
• Medications e.g. opioids, chemotherapy, antibiotics
• Infections – gastrointestinal, any systemic sepsis
• Bulimia
• Pancreatitis
• Cholecystitis
• Peptic ulcer disease

Heartburn/acid regurgitation
Regurgitation of stomach contents into the oesophagus
Heartburn → burning or discomfort in retrosternal area
Acid regurgitation → Sour or bitter tasting fluid coming up into the mouth
In reflux disease the lower oesophageal sphincter muscle is usually weak

Dysphagia
Difficulty swallowing, usually solids initially, progressing to dysphagia with liquids
Causes

• Oesophageal spasm
• Oesophageal stricture
• Oesophageal Carcinoma
• Mediastinal mass
• Neurodegenerative disorder                           

Change in bowel habit
1.  Diarrhoea - decrease in faecal consistency. It may refer to an increased volume or frequency, or change in consistency, of the stool.
2.  Constipation - a delay or difficulty in defaecation, but the interpretation of the term "delay" varies broadly.
Determine what patient means by constipation.

• How often would your bowels normally move?
• How often are they moving now?
• How long has this been going on for?

Causes

• Hypothyroidism
• Hypokalaemia
• Anorexia
• Pregnancy
• Multiple sclerosis
• Low-fibre diet

Gastrointestinal Bleeding

• Haematemesis: vomiting blood [bleeding from upper GIT]
• Melaena: passage of dark black tarry stools [bleeding from upper GIT/
• right side colon/small bowel lesions]
• Bright red blood per rectum: usually indicates bleeding from lower GIT

Causes of upper GIT bleeding

• Peptic ulcer disease
• Oesophageal varices
• Oesophageal/Gastric neoplasm
• Arteriovenous malformations
• Mallory-Weiss tears

Causes of lower GIT bleeding

• Cancers/polyps
• Colitis/ulcers (including Inflammatory bowel disease and infectious)
• Anorectal (hemorrhoids, fissures, and rectal ulcers)
• Diverticular disease
• Jaundice

Jaundice
Yellow discoloration of the sclera or skin
Due to the presence of excess bilirubin

• Have you noticed your skin or your eyes looking a little yellow?
• Has anyone else commented on it?
• Has your urine been any darker (obstructive jaundice)?
• How about your stools – are they paler than usual (obstructive jaundice)?

Causes of jaundice
Increased bilirubin production
Haemolysis [unconjugated bilirubin]
            
Intra-hepatic (Liver disease)

• Viral
• Alcohol
• Drug
• Pregnancy
• Cirrhosis – any type

Extra-hepatic

• Common duct stones
• Carcinoma – head of pancreas/ampulla/bile duct
• Pancreatitis/pseudocyst
• Biliary stricture

Abdominal distension

• Bowel obstruction
• Pregnancy
• Constipation
• Irritable Bowel Syndrome
• Liver disease (ascites)

History of Presenting Complaint
Previous diagnosis of:

• Peptic ulcer disease
• Irritable bowel syndrome
• Jaundice
• Hepatitis
• GIT malignancy
• Inflammatory Bowel Disease – Ulcerative Colitis/Crohns

             Previous abdominal surgery
             Previous OGD/colonoscopy

Past Medical/Surgical History
Other medical/surgical problems
Medication- Determine what medication patient is taking prescribed/over-the-counter
Anti-diarrhoeal agents

• Laxatives
• Anti-emetics
• Analgesics, especially paracetamol (can cause liver damage) and Non Steroidal Anti-Inflammatory Drugs (cause peptic ulcer disease and GIT bleeds)

Allergies
           
Social History

• Married/children
• Employed
• Home situation
• Alcohol - Excessive alcohol use can cause liver problems [cirrhosis]
• Smoking
• High risk behaviour for Hepatitis transmission – travel/sexual behaviour/Intra-
• venous drug usage

Family History

• Bowel cancer
• Inflammatory bowel disease
• Liver disease, e.g. haemochromatosis

Complete Systems Review