Gastrointestinal and Genitouriary - PowerPoint Presentation

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Gastrointestinal and Genitouriary History

Dr

AbdulQader

Said

Murshed

Consultant

General, G.I., &

Laparoscoic

Surgeon

FRCS

Glasg

, FRCSI, Jordanian Board

Wednesday,

27/6/2018

Gastrointestinal SymptomsAbdominal Pain

Appetite

Diet

(

vegetarian, or do they avoid

any particular foods?).

Weight

(change in weight)

Teeth and

taste

(

Can they chew their food?

Do they

have their own teeth? Do they get odd

tastesand

sensations in their mouth? Are there

any symptoms

of water brash or acid brash? (This is

thesudden

filling of the mouth with watery or

acidtasting

fluid

– saliva and gastric acid, respectively.)

)

The

features of a pain that must

be elicited:

Time and nature of onset

Site

Character (burning, throbbing, stabbing,

constricting, colicky, aching)

Severity

Progression

Duration

End

Radiation

Relieving factors

Exacerbating factors

Associated symptoms, e.g. vomiting,

diarrhoea

,

painful micturition, missed or absent periods

Gastrointestinal Symptoms (cont.)

Swallowing (dysphagia,

odinophagia

)

Regurgitation

(

effortless return of food into the mouth

)

Is

it fluid

or solid?

.

Flatulence

(

accumulation of gas in the alimentary canal

). Does the

patient belch frequently?

Does this

relate to any other symptoms?

Heartburn

(

burning sensation

behind

the

sternum,

burning sensation

experienced behind

the sternum, caused by the reflux of acid

into the

oesophagus

.

).

Vomiting

( forcible

ejection of stomach

or intestinal

contents through the mouth as the

result of

involuntary spasms of the

oesophagus

,

stomach and

abdominal

wall).

how

often do

they do so? Is the vomiting preceded by

nausea? What

is the nature and volume of the vomit? Is

it recognizable

food from previous meals,

digested food

, clear acidic (burning) fluid or bile-stained

fluid (bitter-tasting)?

Gastrointestinal Symptoms (cont.)

Haematemesis

(vomiting of

blood

)

Old, altered

blood looks like

coffee grounds

. Not

haemoptysis

?

whether they have had a recent nose

bleed? They may

be vomiting swallowed blood.

Indigestion or abdominal pain (dyspepsia)

(

disdifficulty

in digesting food

and is

usually accompanied by discomfort or

abdominal pain

and often by heartburn and belching

)

Jaundice

(a yellow

colouration

of the tissues as a consequence of excessive quantities of bile pigments accumulating in the blood)

Did

the skin

itch

?

Did the

faeces

or urine change

colour

?

Abdominal distension

Is it painful or accompanied by pain? Does

it affect

their

breathing? Is

it relieved by belching, vomiting, passing

flatus or

defaecation

?

Defaecation

/ Change

in bowel

habit,

‘

diarrhoea

’ (a frequent

and copious

discharge of liquid

faeces

) and ‘

constipation

’(

an infrequent or difficult bowel evacuation of

hard

faeces

),

Difficulty in

defaecation

.

Gastrointestinal Symptoms (cont.)

Rectal

Bleeding,

fresh

(bright)

or

altered

(

black, tarry stool is

called

melaena

).

Recognizable blood may appear in four ways:

mixed

in with the

faeces

;

on

the surface of the

faeces

;

separate

from the

faeces

, either after

or unrelated

to

defaecation

;

on

the toilet paper after wiping.

Flatus, mucus (slime) or pus passage per rectum

Pain on

defaecation

Prolapse

Does

anything come

out of the anus on straining? Does it

return spontaneously

or have to be pushed back?

Incontinence and soiling

Is the patient continent

o

faeces

and flatus?

Gastrointestinal Symptoms (cont.)

Tenesmus

(intense

desire

to

defaecate

). Nothing

or just a small amount

of mucus

and loose

faeces

appears.

Pruritus Ani (

Perianal

itching)

Water brash

Belching

Genitourinary Symptoms

Pain

(renal pain, ureteric colic, vesical pain prostatic pain, testicular pain).

loin

– the space below the 12th rib

and the iliac crest.

renal

angle – the angle between the 12th

riband

the edge of the erector spinae

muscle.

Renal

pain can be a continuous

dull ache

or be sharp and very severe. Do not

use the

term ‘renal colic

’.

True

colic is

autonomically

modulated

and can only come from distension

of the

smooth muscle wall of a conducting tube such

as the

ureter.

Frequency of

Micturition

(during the day,

nocturia

?).

Burning Micturition.

Retention of Urine:

acute and chronic, acute-on- chronic retention.

Haematuria

Hesitancy

(difficulty to

start to pass urine).

Dribbling

(the

inability to finish cleanly).

Urgency

Poor Stream

(

a

reduced rate of urine

flow during micturition).

Urethral discharge

(purulent?).

Mass / swelling

(in the scrotum?).

Ulcer

(in penis, scrotum)

Priapism

(

a persistent, usually

painful erection).

Absence

of one or both

testes from

the

scrotum

.

(ectopic testis, undescended testis).

Female

geintal

system