1. WELCOME BACK
HOPE U HAD A GOOD
LUNCH

3. HISTORY TAKING FOR G.I.T. (SUMMARY)BY
DR WAQAR
MBBS, MRCP
ASSISTANT PROFESSOR

4. Common GIT Presenting complaints
* dyspepsia * heartburn
*abdominal pain * Bloating/gas
* Nausea/vomit * Hematemesis
* melena * Wt loss
* Diarrhea/constip * Weakness
* Jaundice * dysphagia

5. 2) H/O presenting c/o : Ask the details
2) H/O presenting c/o : Ask the details. First ask the duration of all symptoms
Dysphagia : * for solids or liquids? * Getting worse? * Wt loss? * Pain or just difficulty?
( dysphagia first for solids then liquids esophageal cancer. Dysphagia for solids & liquids from the start motility disorders of esophagus like achalasia.
Heartburn : * more supine? What worsens ?
Abdominal pain: * All the usual questions of pain * relation to meals ( PUD, IBS, gallstones, pancreatitis) * Relieved by defecation or vomiting?

6. d) Bloating/gas :. Related to any specific food
d) Bloating/gas : * Related to any specific food? *Any recent change in diet habits * Recent travel? * Any chronic constipation? (constipation often causes gas feeling) e) Vomiting : * frequency * projectile or just regurgitation? * Aggravating/relieving factors f) Hematemesis: * color( bright red, dark) * Use of NSAIDs or warfarin? * Is there any epigastric pain? ( ulcer disease) *Any past history of liver disease? (variceal bleeding) g) Melena : * Color ( dark, bright red). Fresh blood indicates lower GI bleed( hemorrhoids, proctitis, colitis) * Relation to stools * Any pain?

7. h) Diarrhea/Constip. :. frequency
h) Diarrhea/Constip. : *frequency * stool consistency ( watery, hard or semi) * Any worms in stool? * Easy to flush? or floating? ( in malabsorption not easy to flush) * Relation to eating?( in IBS, often passing stools after eating) * Recent restaurant visit? * Any recent or past travel? (traveller’s diarrhea caused by E.Coli) * Other people affected? (food poisoning) *related to any specific food? (milk lactose intolerance, wheat celiac disease) * Detailed drug history

8. Jaundice :
* Duration
* Fluctuating( Gilbert syndrome) or persistent?
* Eating habits? ( restaurant or home). Restau-
-rants chances of Hep A
* Travel history ( hep A from unclean food & water)
* Hist. of blood transfusion? ( Hep B, C)
* Wt. loss, abd. pain? ( Pancreas cancer, hepa-
-titis).

9. Jaundice (contd) History of i.v. drugs? ( hep B & C)
Any past hepatitis?
H/O any hemolytic anemia?
Fam. History of jaundice/liver disease
Any hepatitis in the spouse ( husband/wife)
Any itching alongwith jaundice? ( obstructive jaundice eg. Common bile duct stone, carcinoma of head of pancreas)
* Alcohol use?

10. 3) Past history 4) Medical/Surgical history 5) Personal/ Social hist
3) Past history 4) Medical/Surgical history 5) Personal/ Social hist.( iv drugs, addictions, travel, anxiety IBS). Very imp in liver dis. 6) Allergies/Medicines/Occupation 7) Family history ( malabsorption, liver dis.) 8) Drugs ( can cause PUD, Jaundice, Gas, diarrhea etc)

11. If the history suggests a diagnosis, ask specific questions about that disease

12. WAIT !
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