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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 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 Dysphagia Odynophagia Diarrhoea Constipation
Bloating • Bleeding • Haematemesis • Melena • Haematochezia • Jaundice • Dark urine, pale stools • Pruritis • Lethargy • Fever
SOCRATES • Site • Onset • Character • Radiation • Alleviating factors • Timing • Exacerbating factors • Severity
GERD Site? RETROSTERNAL
GERD Onset and timing BENDING OVER AND LYING DOWN
GERD Character BURNING BITTER / SOUR FLUID IN MOUTH
GERD Radiation TO NECK
GERD Alleviating factors ANTACIDS
GERD Exacerbating factors
PUD Site EPIGASTRIC
PUD Onset and timing MEALS GASTRIC ULCER = WORSENS DUODENAL ULCER = IMPROVES
PUD Character BURNING DULL
PUD Radiation TO BACK
PUD Alleviating factors ANTACIDS
PUD Exacerbating factors OFTEN SPICY FOOD, NSAIDs
PUD • RISK FACTORS? • NSAIDs • Alcohol • Smoking • H. pylori infection • Stress
PUD • Stool changes MELENA • Vomitus COFFEE-GROUND
PUD Vomitus RED BLOOD
Pancreatic disease Site EPIGASTRIC
Pancreatic disease Onset and timing PAIN WITH MEALS
Pancreatic disease Character DULL, STEADY
Pancreatic disease Radiation TO BACK
Pancreatic disease Alleviating factors
Pancreatic disease Exacerbating factors MEALS ALCOHOL LYING DOWN
Biliary disease Site EPIGASTRIUM = COMMON BILE DUCT RIGHT HYPOCHONDRIUM = CYSTIC DUCT
Biliary disease Onset ACUTE EPISODES OF RECURRING PAIN
Biliary disease Character USUALLY SEVERE, CONSTANT, LASTS FOR HOURS CAN BE COLICKY
Biliary disease Radiation RIGHT SHOULDER
Renal calculi Site FLANKS RENAL ANGLE
Renal calculi Onset and timing ACUTE
Renal calcul Character SEVERE, COLICKY PAIN
Renal calculi Radiation GROIN
Renal calcul Alleviating factors ROLLING AROUND OFTEN IMPROVES PAIN
Bowel obstruction Site and radiation SMALL BOWEL = UMBILICUS LARGE BOWEL = NON-SPECIFIC