Gastrointestinal and Genitouriary History Dr AbdulQader Said Murshed Consultant General, G.I., & Laparoscoic Surgeon FRCS Glasg, FRCSI, Jordanian Board Wednesday, 27/6/2018

Gastrointestinal Symptoms Abdominal 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