Alimentary: History
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).

Alimentary Exam