gastrointestinal disorders
Evaluation of the Gastrointestinal Patient
History in the GI Patient
Using open-ended, interview-style questions, the physician identifies the location and quality of symptoms and any aggravating and alleviating factors. is a frequent GI complaint (see Acute Abdominal Pain and Asking patients about radiation of pain may help clarify the diagnosis. For example, pain radiating to the shoulder may reflect Acute Cholecystitis because the gallbladder may be irritating the diaphragm. Pain radiating to the back may reflect Patients should be queried about changes in eating and elimination. Regarding eating, patients should be asked about difficulty swallowing ( Dysphagia ), loss of appetite, and presence of Regarding elimination, patients should be asked when their most recent bowel movement was, how frequently they have been having bowel movements, and whether this frequency represents a change from their typical frequency. It is more useful to ask for specific, quantitative information about bowel movements rather than simply asking whether they are constipated or have diarrhea because different people use these terms quite differently. Patients should also be asked to describe the color and consistency of the stool, including whether stool has appeared black or bloody (suggestive of GI bleeding), purulent, or mucoid. Patients who have noticed blood should be asked whether it was coating the stool, mixed with stool, or whether blood was passed without any stool. A History is important in women because gynecologic and obstetric disorders may manifest with GI symptoms. Associated nonspecific symptoms, such as Fever or Patients report symptoms differently depending on their personality, the impact of the illness on their life, and sociocultural influences. For example, nausea and vomiting may be minimized or reported indirectly by a patient with severe depression but presented with urgency by a patient who is anxious. Important elements of the past medical history include presence of previously diagnosed GI disorders, previous abdominal surgery, and use of medications and substances that might cause GI symptoms (eg, nonsteroidal anti-inflammatory drugs [NSAIDs], alcohol). 