The GI History

Please review this information thoroughly – these are the key questions to ask for each of the following presentations:

Dysphagia

1. 1. Transfer dysphagia is characterized by coughing, choking, or nasal regurgitation. If present ask about cranial nerve symptoms.
   2. Esophageal dysphagia is characterized by sticking further down. The patient often perceives food as sticking higher up than it actually does.
   3. Onset, frequency, intermittent vs progressive
   4. Solids, liquids, both
   5. What happens when food sticks ? Does it pass with repeated swallows ? Do they need to drink water ? Special maneuvers (eg lift arms up). What proportion of the time do they bring it up ?
   6. Have they had to modify their diet ? (Solids & liquids vs mechanincal soft vs liquid)
   7. Zenkers: lump in neck, gurgling sound
   8. Other: weight loss, GERD symptoms (current or past), odynophagia (pain with swallowing), globus (feeling of a constant lump in the throat)

Heartburn/GERD

1. 1. Symptoms
      1. Heartburn – retrosternal burning
      2. Reflux – bitter taste at back of mouth
      3. Other – waterbrash (rare) – fits of oral secretion +/- triggered by reflux
   2. Onset, frequency, progression
   3. Timing: time of day, relation to meals, duration, evening, does it wake the pt.
   4. Treatments: drugs, doses, duration, response
   5. Risk factors: nicotine, caffeine, smoking, chocolate, peppermint, alcohol
   6. Systemic diseases: diabetes, scleroderma, other connective tissue disease, Raynaud’s
   7. Extra-esophageal manifestations: cough, hoarseness, sore-throat, dental erosions, globus, pneumonia

Nausea/Vomiting

1. 1. Onset, frequency, progression, viral illness
   2. Timing: time of day, relation to meals, stress, etc
   3. Characteristics:
      1. food vs gastric secretions/bile
      2. have they clearly seen food from the day before
      3. blood (hematesis
   4. SBO symptoms: acute onset, associated pain, stop passing gas. Suddenly resolves +/- ‘diarrhea’
   5. Complications: lightheaded, hospitalizations, weight loss, proportion of food kept down
   6. Treatments & response
   7. Systemic diseases: diabetes, scleroderma, other connective tissue disease, Raynaud’s
   8. Associated symptoms: diarrhea, headaches, cranial nerve
   9. Need to differentiate from regurgitation which is the non-forceful bringing up of recently ingested food.

Abdominal Pain

P – provocation – meals, movement, bowel movements
P – palliations – treatments & response
Q – quality – dull/sharp, steady/crampy
R – radiation (where does it go to)
S – severity – scale of 1 to 10, effect on their function
T – timing – frequency, duration, course & progression
Associated symptoms: vomiting, passing gas pr etc

Constipation

1. 1. Onset, progression, frequency of BMs (‘anything coming out’)
   2. Character – change in form, scyballous (like pellets)
   3. Straining, digital disimpaction, incontinence, ER visits
   4. Obstructive (strain with no response) vs inertia (don’t get the urge to go)
   5. Associations: blood, melena, pain (? Relieved by BM), nausea/vomiting, weight loss, abuse (physical, sexual, emotional), Raynaud’s
   6. Diet (fiber), fluid, exercise
   7. Treatments & response

Diarrhea & Inflammatory Bowel Disease (Crohn’s & Ulcerative Colitis)

1. 1. Onset, course, progression
   2. BMs: frequency (day/night), consistency, blood (trace, 25%, 50% etc), cramps, tenesmus (feel they need to go, but nothing comes out)
   3. Treatments & response (note dose & duration)
   4. Extra-intestinal manifestations of IBD : painful red eyes, arthritis, low back pain, ulcers (skin, oral)
   5. Risk factors: travel, untreated water, new medications
   6. Steatorrhea: float or sink, how many times need to flush, see oil, smell
   7. Other: surgeries, family history IBD, recent NSAIDs
   8. IBD Rx: Dose, duration, compliance, response, hospitalisations

Abnormal Liver Function Tests

1. 1. Past history, knowledge
   2. Risk factors: Tattoo, acupuncture, IV drug abuse, alcohol, blood transfusion, STDs, multiple sexual partners, cocaine (nasal), herbal products, new medications (even a single dose), travel, family history
   3. Symptoms: jaundice, itching, sleep reversal
   4. Chronic liver symptoms: bleeding, increased abdominal girth

GI Bleeding

1. 1. Eyeball patient +/- orthostatics – are they stable ?
   2. Onset, progression, frequency, last event
   3. Hematemesis, coffee emesis, hematochezia (red), melena
   4. Complications: presyncope (postural lightheadedness), syncope (lost consciousness), chest pain, SOB
   5. Risk factors: ASA, NSAIDs, ‘anti-inflammatories’, coumadin
   6. History: PUD, bleeds, AAA repair, IBD, anemia, any other GI symptoms
   7. OK to scope: symptoms of angina, CHF, need SBE prophylaxis ?