Assessing abdominal pain through history taking and physical. In order to obtain an accurate health history regarding the gi system, appropriate questions need to be asked with terms the patient will understand. Taking a history when the patient complains of constipation. Ensure the environment is comfortable and allows the child to be occupied while you gather information. Gastrointestinal system examination surface markings liver upper border 5th ics right on full exp lower border at costal margin on full inspiration spleen behind left 9,10,11 ribs, posterior to mcl kidneys upper pole lies deep to the 12th rib posteriorly, 7 cm from the midline, the right is 23 cm lower than the left. Gastrointestinal history introduction 1 introduces themselves 2 con. Clinical examination a comprehensive collection of clinical examination osce guides that include stepbystep images of key steps, video demonstrations and pdf mark schemes. An overview of the gastrointestinal system clinical methods. Jan 31, 2014 a detailed health history would include multiple systems of the body, however, we will be focusing on the gastrointestinal gi system. Important points to cover with the patient are the location and duration of the pain, any change in its location or intensity, any known precipitating factors, and any associated symptoms fever, chills, nausea, vomiting, or change in bowel habits. Gastrointestinal history taking mark scheme geeky medics.
It is important to begin by obtaining a thorough history of abdominal or gastrointestinal complaints. General approach to history taking and physical exam of the. All patients with significant upper gastrointestinal bleeding should be started on intravenous proton pump inhibitor therapy until the cause of bleeding has been confirmed with endoscopy. Sep 15, 2012 history taking upper gastro intestinal bleeding 1. Features upper gi bleed lower gi bleedsite above ligament below ligament of treitz of treitzpresentation hemetemesis or hematochezia malenanasogastric blood clear fluidaspirationbowel sounds hyperactive normalbun creatinine increased normalratio. Definition the world health organization defines diarrhea as the passage of three or more loose, watery stools per day however, any deviation from a childs regular stoolpassing behavior is a cause of concern and, clinically, a better working definition is any increased frequency or decreased consistency of s. Jan 02, 2015 the gastrointestinal tract extends from the lips to the anus and includes the liver, biliary system and pancreas although, for the purpose of this article, consideration will start at the oesophagus, as problems with dentition or with salivary gland disorders and tumours are covered elsewhere. Comprehensive history taking and clinical examination skills are examples of role development for a stoma care nurse specialist. All usmle step 2 cs stations are of 15 minutes long and require focused history taking, physical examination, and counselling as needed. History taking other skills osce skills medistudents. When taking an abdominal history, work through socrates before moving onto associated symptoms and abdominal history red flags. The gastrointestinal tract extends from the lips to the anus and includes the liver, biliary system and pancreas although, for the purpose of this article, consideration will start at the oesophagus, as problems with dentition or with salivary gland disorders and tumours are covered elsewhere. The abdominal pain history taking osce is a very common station and is often combined with an acute abdomen exam or a simple procedure such as urinalysis.
The doctors agenda, incorporating lists of detailed questions, should not dominate the history taking. Taking and physical examination of the upper gastrointestinal tract evan s. History of relapsing and remitting epigastric pain, now with acute abdomen perforated peptic ulcer. For medical especially mbbs students and interns, medical history is a vital thing to learn, understand and interpret in order to become a professional doctor. This guide structures the history in parallel with the structure of the gi.
This guide structures the history in parallel with the structure of the gi system, beginning at the mouth and working downwards. The gastrointestinal tract extends from the lips to the anus and includes the liver, biliary system and pancreas although, for the purpose of this. Gastrointestinal symptoms, seizure disorders, sleep problems, and medication use were determined from parent report. General history taking taking the history of a patient is the most important tool you. This report describes a cirrhotic female patient with no history of bleeding or other gastrointestinal disorder who experienced fatal gastrointestinal bleeding gib after taking apixaban which is a direct oral anticoagulant doac for one month for management of chronic nonvalvular atrial fibrillation. G is a 54yearold hairdresser who reports pressure over her left chest like an. Jan 16, 2019 a good history is one which reveals the patients ideas, concerns and expectations as well as any accompanying diagnosis. May 31, 20 gastrointestinal gi endoscopy allows direct visualization of the interior of the gi tract and is frequently performed to investigate symptoms, confirm diagnosis, and offer treatment. Gastrointestinal gi symptoms and disorders are quite common. The ability to take a focused gastrointestinal history as part of your patient assessment is an important skill that is often examined. History and physical examination are often adequate to make a disposition in patients with. The next significant development was the instrument of desormeaux in france. Dellon center for esophageal diseases and swallowing, division of gastroenterology and hepatology, university of north carolina school of medicine, chapel hill, nc, usa. The child should feel involved, but the parents may have more objective or detailed observations.
When youre finished, you take a last drink of milk, wipe your. Evaluation of the gastrointestinal patient gastrointestinal disorders. I overview on gastrointestinal pharmacology stefano evangelista encyclopedia of life support systems eolss carbonic anhydrase and passively enter the gastric venous blood, raising its ph. Past history surgery might have directly damaged the bile duct might have had a length of gut removedanaesthesia causes jaundice i. Pediatric gi history taking principles use your judgement when asking questions. This chapter discusses an approach to the history and physical which emphasizes developing a physician. Gastrointestinal history taking requires a systematic approach to ensure you dont miss anything important. Child behavior checklist cbcl scores were used to measure behavioral symptoms. Diagnosis and management of upper gastrointestinal bleeding. The use of apixaban, coupled with the predilection for hemorrhage in cirrhotic patients. History of the instruments for gastrointestinal endoscopy. Preparation and patient evaluation for safe gastrointestinal. Past medical history 19 previous gastrointestinal disease 20 other medical history 21 surgical history drug history 22 prescribed medications 23 over the counter medication 24 allergies family history 25 gastrointestinal disease including age of onset. Pharmacology of common agents used in gastrointestinal conditions.
This is the 3rd cpmc admission for this 83 year old woman with a long history of. Over time you will stop using this approach and only ask a smaller more focused subset of these questions. Pediatric gastrointestinal history taking learn pediatrics. Pain is the most common complaint related to abdominal problems. Notes so there you are, sitting at lunch, enjoying some grilledchicken pizza and a few orange wedges. Aug 07, 2012 examination of gastrointestinal system by hx 1. Hypoxaemia of liver cells causing ischaemic hepatitis. Pregnancy risk, if high consider ectopic pregnancy. C linical history taking is an art of extracting out the smallest of information from the patient and reaching to a possible diagnosis. A collection of gastrointestinal examination osce guides, including abdominal examination, rectal examination pr and hernia examination. Cureus fatal nonvariceal gastrointestinal bleeding in a. Acid is essential for activation of the protease pepsin to initiate protein digestion.
Foundations of physical examination and history taking. Comprehensive history taking is a thorough exploration of a patients presenting complaint and the gathering of subjective information, while clinical examination is the gathering of objective information from a head. Historytaking and clinical examination skills from a stoma. Thus, ignore the last statement in the following sample stations about the available time and required tasks to do. Summary the history and physical exam remains the cornerstone of.
General approach to history taking and physical exam of the upper. Many of these can be prevented or minimized by maintaining a healthy lifestyle, practicing good bowel habits. Taking the history of a patient is the most important tool you will use in. Introducing our gastrointestinal history guide by dara r. Example of a complete history and physical writeup patient name. History taking in medicine and surgery third edition jonathan m. You will need to elicit information about any complaints of gastrointestinal disease or disorders.
Altered bowel habit constipation diarrhoea fresh blood malaena. Colicky gut or ureter obstruction aggravating factors. Although one can use the generalised template to obtain an. The structural basis of history taking 1 how to present the history abdominal masses and distension 16 acute abdominal pain 22 alcoholrelated problems 33 anorectal pain 42 back pain 46 breast lump 54 change in bowel habit 59 chest pain 63 collapse, syncope and blackouts 71 confusion 78 constipation 85 cough 91 depression and anxiety 98.
Dec 03, 2016 introducing our gastrointestinal history guide by dara r. In the past, the realm of gi tract for endoscopists has chiefly been limited to the upper and lower gi tract, and the small bowel has largely been considered a. The history of gastrointestinal endoscopy clinical gate. Gastrointestinal disorders include such conditions as constipation, irritable bowel syndrome, hemorrhoids, anal fissures, perianal abscesses, anal fistulas, perianal infections, diverticular diseases, colitis, colon polyps and cancer. Gastrointestinal disease can present with a wide variety of symptoms affecting oral intake, the abdomen, bowel motions and the patients. Sept 2009, david lapierre the abdominal history and physical exam is important to assess gastrointestinal concerns, but can also help identify problems with the heart, aorta, spine, kidneys, pelvis, and peritoneal cavity. History taking, physical examination, endoscopy, imaging studies and other laboratory tests are variably required for total assessment, evaluation, and concrete diagnosis.