1. Pain and discomfort
2. Dysphagia
3. Nausea, vomiting, and reflux
4. Stools
5. Other systemic
6. Past medical, surgical history
7. Family, social, drug history
8. Systems

Pain and discomfort

• SOCRATES
  • Character: colicky [in waves] vs. not.
  • Alleviating, exacerbating factors: meals, any certain foods, vomiting, exercise, antacids, stress, defecation, flatus.
• Pain dz hallmarks:
  • Colicky (GI or ureter obstruction). Small bowel: 3min. cycle. Large: 10min. cycle.
  • Localized, relieved by staying still (peritonitis).
  • Burning, relieved by food or antacid (heartburn).
  • Steady pain, relieved by sitting up, leaning forward (pancreatic).
  • Severe pain for hours, prior attacks (biliary).
  • Constant pain overlying severe pain radiating to groin (renal).

Dysphagia

• Location of food sticking.
• Intermittent vs. worsens during meal vs. eases during meal.
• Cannot initiate swallow vs. choking on swallow.
• Painful vs. painless.
• Painful on swallowing: "odynophagia" (inflammatory processes).
• Solids worse vs. liquids worse.
• Changes since onset.

Nausea, vomiting and reflux

• Timing of vomit:
  • Morning (pregnant, raised ICP, ethanol).
  • 1hr post-meal (gastric outlet obstruction,  gastroparesis).
• Vomit contents:
  • Blood.
  • Bile.
  • Old food (pyloric stenosis) vs. new food. 
• Colour:
  • Yellow-green (bile, from obstruction).
  • Coffee grounds (altered blood).
  • Hematemesis.
• Projectile (pyloric stenosis, raised ICP).
• GERD, acid regurgitation:
  • Relieved by raising head of bed.

Stools

• Frequency: constipated vs. diarrheic.
  • And what would be your normal frequency for yourself?
• Amount.
• Blood: melena [black stool], hematochezia [bright red stool].
• Pale, fatty, buoyant stool (steatorrhea 2° to fat malabsorption).
• Odour.
• Mucous: mixed with stool or not.
• Consistency: hard vs. soft, watery.
• Painfulness of defecation.
• Needing to strain alot on defecation.

Other systemic

• Wasting, weight loss vs. gain.
• Anemia, jaundice, bronze diabetes. See Skin Colors Reference.
• Lethargy (liver dz).
• Abdominal swelling.

Past medical, surgical history

• Current complaint in the past.
• Post-op from a recent operation (anesthetic s/e, damaged GI).
• IBD.
• Ulcers.
• Past surgeries, treatments.

Family history

• Current complaint in family member (acute: food poisoning).
• Heritable bowel dz.

Social history

• Smoking: ever smoked, how many per day, for how long, type [cigarette, pipe, chew] (ulcers).
• Alcohol (cirrhosis, gastritis).
• Occupation (hepatitis), others at workplace with similar.
• Stress level (ulcers).
• Toxin exposure (liver dz).
• Travel, sex, IV, tattoo use (hepatitis).

Drug history

• Laxatives.
• Indigestion medications.
• NSAIDs (GI bleed).
• Liver-damaging drugs.
• Steroids.
• Allergies.
• Allergic reactions to drugs.

Systems

• Dark urine (jaundice).
• RHF signs (nutmeg liver).

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